AFCPE | Conference Registration

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	2011 Conference Registration This contact information will be used to contact you during the 2012 membership year, and will be included in the 2011 conference attendee listing.

	Personal Information
	Name* First Name Last Name Suffix
	Address* City State/Province Zip/Postal
	Fax
	Work Phone*
	Email*
	Affiliation
	Military Installation (if applicable)
	Name as you would have it appear on nametag*
	First AFCPE Conference?* Yes No

	Conference Registration (Includes 2012 Membership)
	Wednesday, November 16, 2:00 p.m. through Friday, November 18, 3:00 p.m. Please note that AFCPE membership is a separate division from the certification programs.
	Membership Status and Registration* 2011 Member ($470) Non-Member ($545) Full Time Student (12 cr. hours) ($335)
	Student Attendees Those registering at the student rate must meet the criteria of student membership per AFCPE by-laws. The APFCE bylaws defines student membership as: Student Membership in the Association shall be open to individuals studying in the field of personal financial counseling, planning or education. Such individuals must be studying full-time at the college or university undergraduate or graduate level.
	Pre-Conference Dates and Times: Cooperative Extension: November 16, 7:00 am - 1:30 pm
	Pre-Conference Registration Option Cooperative Extension ($85)
	2012 Certification Fees Accredited Credit Counselor (ACC) $30 Accredited Financial Counselor (AFC®) $45 Certified Housing Counselor (CHC®) $60
	Total Payment $

	Continuing Education Certificates Automatically given to ACC℠ , AFC®, AFC® Canada, and CHC® certificants
	Continuing Education Certificates AAFCS Professional Development Units CFP Continuing Education Units
	If you have special food needs, please check one of the following. Your meal ticket will reflect the special need.
	Special Meal Accommodations Vegetarian Low Sodium Gluten Free
	Cancellation Policy Registrations cancelled prior to October 1, 2011 will be refunded minus a $30.00 cancellation fee. Due to financial obligations incurred by AFCPE^®, there will be a $200 cancellation fee for any cancellation requests received between October 1, 2011 and November 4, 2011, 5:00 PM EST. There will be no refund of registration fees after November 4, 2011, 5:00 PM EST. We will allow substitutions free of charge until November 14, 2010, 5:00 PM EST. All cancellation and substitution requests must be submitted to AFCPE^® in written form via email, conference2010@afcpe.org. Registration Deadlines Registrations submitted on-line, faxed or mailed will be processed at the fees outlined on the registration form above. Registrations received or postmarked on or before October 1, 2011 will be processed at the early bird registration fee. Registrations received or postmarked October 2, 2011 through November 4, 2011 will be processed at the registration fee noted. After November 4, 2011, all applications must be processed onsite at the AFCPE^® registration desk at the Hyatt Regency Jacksonville-Riverfront. Student Attendees Those registering at the student rate must meet the criteria of student membership per AFCPE by-laws. The APFCE bylaws defines student membership as: Student Membership in the Association shall be open to individuals studying in the field of personal financial counseling, planning or education. Such individuals must be studying full-time at the college or university undergraduate or graduate level. DoD and Military Services Registration Policy To accommodate the September 30, 2011 fiscal year end, any member or employee of the Armed Services may register by October 1, 2011 at the early bird rate by providing credit card payment information. Credit cards will be charged beginning October 31, 2011. Please note that providing credit card information obligates you to pay for a registration. Cancellations after October 1, 2011 will be charged a $200 cancellation fee. Please note, if you are eligible to use Form 1556, you may also register and pay using a Form 1556. Conference Confirmation Upon receipt of your conference registration form, you will receive an e-mail confirmation. Please keep your confirmation e-mail for your records.

	Payment Information
	Cardholder Name* First Name Last Name
	Cardholder Email*
	Billing Address* City State/Province Zip/Postal
	Credit Card*
	CCV Number* 3 or 4 digit security number on back of card
	Expiration Date* Month Year

2011 Conference Registration

This contact information will be used to contact you during the 2012 membership year, and will be included in the 2011 conference attendee listing.

Personal Information

Conference Registration (Includes 2012 Membership)

Pre-Conference Dates and Times:

Continuing Education Certificates

Automatically given to ACC℠ , AFC®, AFC® Canada, and CHC® certificants

Payment Information

This contact information will be used to contact you during the 2012 membership year,
and will be included in the 2011 conference attendee listing.