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2024 Registration Form
aglsbackend
2024-02-07T18:43:33-05:00
2024 Registration Form
2024 Registration
Registration form for the 2024 Constitute in Portland, OR
Name of Person Completing Registration Form(s)
*
First
Last
Institution of Person Completing Registration Form(s)
*
(e.g. State University, Bigtown College-Secondcampus, etc.)
Preferred Email of Person Completing Registration(s)
*
in case there is a question
Campus Phone of Person Completing Registration(s)
*
in case there is a question
Is there a gen ed committee/program/office/department/school on campus?
*
Yes
No
What is the official name of the above gen ed entity?
Is there a person who overseas the gen ed entity on your campus?
*
Yes
No
This could be an administrator, committee chair, director, etc.
Please provide the name, position title, and email address of the person(s) who oversee the gen ed entity on your campus (if applicable).
If available, campus address for above gen ed entity.
(e.g. Main Hall Rm 100, MC1000, etc.)
If available, web address to the above gen ed entity.
(e.g. www.stateuni.edu/gened)
I understand I may be contacted with questions regarding the registration(s) submitted.
*
I understand
Do you have more than 5 people to register?
*
Yes, please contact me about registering a group of 6 or more. [hit submit to end registration; we will contact you within 48 hours]
No, I have 5 or fewer to register. I will complete the form below.
I am registering for:
*
Myself Only
Myself and Others
On behalf of one person
On behalf of a group
Registration for Attendee #1
*
full registration
Friday only registration
Saturday only registration
Attendee #1 Name
*
First
Last
Attendee #1 Preferred Email
*
Do you have a second attendee to register?
Yes
No
Registration for Attendee #2
full registration
Friday only registration
Saturday only registration
Attendee #2 Name
First
Last
Attendee #2 Preferred Email
Do you have a third attendee to register?
Yes
No
Registration for Attendee #3
full registration
Friday only registration
Saturday only registration
Attendee #3 Name
First
Last
Attendee #3 Preferred Email
Do you have a fourth attendee to register?
Yes
No
Registration for Attendee #4
full registration
Friday only registration
Saturday only registration
Attendee #4 Name
First
Last
Attendee #4 Preferred Email
Do you have a fifth attendee to register?
Yes
No
Registration for Attendee #5
full registration
Friday only registration
Saturday only registration
Attendee #5 Name
First
Last
Attendee #5 Preferred Email
Institutional Member Discount
Available for institutions that paid 2024-25 Institutional membership
Would you like to pay now with a credit card OR have AGLS send you an invoice?
*
Pay now via credit card / Paypal
Invoice me
Please enter name and email of person to receive invoice via email
Please send an invoice for above registrations to the following person – provide name and email above. (e.g. Jane Smith, jsmith@unitown.edu) NOTE: Registrations are not active until payment is received.
If paying with a credit card now
*
PayPal is the AGLS credit card processing portal. You DO NOT need to have a PayPal account. You can pay with a credit card. Simply select the option to pay as a guest/with a credit/debit card.
I Understand
Total
$0.00
Comments
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