2019 Conference Registration – Members NB: This registration form is for current ASPAH members only. If you are not a paid-up member of ASPAH, please join ASPAH before registering or use the form for non-members here. First Name*Last Name*Email* State* State / Province / Region Phone*Dietary requirementsWe will endeavour to cater to dietary requirements as best we can. Please provide specific details about your requirements, especially if serious allergies are a factor.Please indicate any of the following categories that you identify with:* Healthcare provider Performing Artist Technical/support crew Researcher Educator (healthcare) Educator (performing arts) Student Other How did you hear about the 2019 ASPAH Conference?* Facebook Twitter Linkedin ASPAH Newsletter Word of mouth MPPA Journal Dancetrain Magazine Other Registration Type*NB: Concession rate is for full time students and holders of an Australian Commonwealth Pensioner or Health Care Card.Full Conference - $395.00Full Conference Concession - $335.00Saturday Only - $295.00Saturday Only Concession - $250.00Sunday Only - $295.00Sunday Only Concession - $250.00Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.