Register for the Conference

Below is the registration form for the Annual leadership conference. Please fill out all fields, before submitting the form. Due to the high volume of registrations we receive, there may be up to a five day delay in receiving your confirmation. If you have not received confirmation, after one week, please email the Academy, and we will verify your registration form was received.

Please do not call for payment, until you receive the email confirmation.

All active conference sponsors are listed in the pull down menu. If your organization is not listed, then you should select the standard rate.

Thank you for your support of the Chair Academy Conference.

Pre-Conference Skill-Building Workshops (Select only ONE)		Pre-Conference Skill-Building Workshops April 7, 2015 Full Day - $125.00 (unless specified) 9:00 am to 3:30 pm This fee includes: coffee and juice in the morning, AM refreshment break, and materials
	None
$125	The Trick to Being a Chair or Organizational Leader
$125	Strengths Educator Workshop
$125	Leadership Development 3.0: The Times They are a Changing
$125	Creative Leadership: Thinking, Working and Leading With Vision
$125	Learning Spaces That Measure Up: Planning Learning Spaces for the 21st Century
To read the session summary, please hover over the session title

Conference Registration Costs (Select only ONE)				Full Conference Attendance Includes: Three - Breakfasts Three - AM breaks Two - PM Breaks Welcome Reception (April 8, 2015) One Plated Lunch (April 9, 2015) Access to All General Sessions
	Full Conference Rates - April 8-10, 2015
		$500.00	Standard Conference Rate
		$400.00	Conference Sponsor/Conference Host/Academy Facilitator You must select your Organization from the list below, to receive this rate.

		$450.00	Academy Member Rate You must have a PAID, Active, Membership at the time of registration
	Single Day Conference Rates - April 8, 9, or 10, 2015 only
		$250.00	Wednesday, April 8, 2015 only.
		$250.00	Thursday, April 9, 2015 only.
		$250.00	Friday, April 10, 2015 only.

Participant Information (All fields mandatory)

Full Name:

Nick Names are allowed.

Title/Position:

College:

Address:

City:

State/Province:

Postal/Zip code:

Country:

Email:

Verify Email:

Phone:

Fax:

Dietary Restrictions:

Please check this box if you are a Vegetarian
Please check this box if you have a Gluten Allergy

Special, more restrictive diets, should be addressed
with the Conference Hotel, they will endeavor to work with you.

Additional personal charges may apply.

Executive Assistant Name:

Executive Assistant Email:

Executive Assistant Phone:

Emergency Contact Information

Full Name:

Email Address:

Phone:

WERE YOU REFERRED BY A COLLEAGUE?
Tell us who referred you, and we will reward their support.

Referee's Name:

Referee's Email:

	Cancellation Policy
	Notification of cancellation before the conference	Cancellation Fee
	After 03/15/2015	$250
	No Notification/No Show	Full Registration Fee Cost
	An invoice and confirmation email will be sent to you within 5 business days. Do not contact the Chair Academy until you receive the confirmation email with your invoice. Payments must be received IN FULL, prior to the Conference. Any and all cancellations MUST be submitted to the Chair Academy, in writing, via email, BEFORE 03/14/2015. Checks are the preferred method of payment, but credit cards are accepted. We currently DO NOT have online payment capabilities. Credit Card payments can be made/processed Monday-Thursday
	Please read the following conditions and sign below.
	If you need to completely cancel your registration, it is your responsibility to contact the Chair Academy in writing to do so. Contact the Chair Academy at conference@chairacademy.com The Chair Academy will contact you to confirm any cancellation we receive. If the Chair Academy is not notified in writing of your cancellation and you do not attend, you will be charged the full amount. Your photo may be taken during the events being held at conference. Your image may be used in future Chair Academy promotional materials. This includes website, flyers, social media, and any other media format. The Chair Academy is committed to complying to the provisions, of Title II, of the Americans with Disabilities Act. We ask that requests, for any special needs, be submitted to us within a reasonable timeframe (60 days, if possible), to make appropriate arrangements. By signing/submitting this form you have read and agree to the photo and cancellation policy.
	Please type your name in the field below to agree to the above conditions.
	Please answer this simple security question... What is the third word from this list? Airplane, textbook, next, plum