You may pay online via credit card or send a check through the mail. U.S. locals may pay by e-check.

Registration Fee (USD):

$225 – early bird fee through June 1st
$275 – regular fee after June 1st

How will you be attending?	Registrant Staff	* Required
Registration Fee (USD):		Must be in money format (10.00). Required
District Number:	1 3 4 5 6 7 8 9 10 11 12 13	* Required
Local Union Number:		* Cannot exceed 10 characters. Required
Form Completed By:
First Name:		* Cannot exceed 25 characters. Required
Last Name:		* Cannot exceed 25 characters. Required
Position:		Cannot exceed 50 characters.
Email:		* Must be in email format (name@domain.com). Required
Phone Number:		* Cannot exceed 15 characters. Required
Delegate Information:
First Name:		* Cannot exceed 25 characters. Required
Last Name:		* Cannot exceed 25 characters. Required
Position:		* Cannot exceed 50 characters. Required
Employer:		* Cannot exceed 50 characters. Required
Email (No company email)**:		* Must be in email format (name@domain.com). Required
Cell Phone Number**:		Cannot exceed 15 characters.
Comments/Questions:
**Contact information will be used to receive updates and information regarding the HealthCare Workers Council.

How many letters exist in the following word: sake

. You answered with an incorrect number of letters.

* = Required Field