Registration Back to Conference Information 2023 Annual Meeting & Conference Registration "*" indicates required fields First Name* Last Name* Nickname for Badge* Company/Firm* Mailing Address* City* State* Zip* Phone Email* NC State Bar License # (for CLE credit)* Please type "NA" if not requesting.Has any of your information changed since your membership renewal?* Yes No If not currently a member of the NCSHCA, are you interested in joining? Yes No Will you attend the Networking Reception on Thursday, November 2?* Yes No Registration Type*NCSHCA MemberNon-MemberGovernment/Non-ProfitStudentNCSHCA Member Registration Fee On or Before October 6, 2023 Fee On or After October 7, 2023 Non-Member Registration Fee On or Before October 6, 2023 Fee On or After October 7, 2023 Government/Non-Profit Employee Registration Fee On or Before October 6, 2023 Fee On or After October 7, 2023 Student Registration Fee On or Before October 6, 2023 Fee On or After October 7, 2023 Total Pay by:*Check (mail your payment to POB 1038, Wake Forest, NC 27588)Credit CardPayment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name