Registration Back to Conference Information 2024 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 Registration Type*NCSHCA MemberNon-MemberGovernment/Non-ProfitStudentNCSHCA Member Registration Fee On or Before August 23, 2024 Fee On or After August 24, 2024 Non-Member Registration Fee On or Before August 23, 2024 Fee On or After August 24, 2024 Government/Non-Profit Employee Registration Fee On or Before August 23, 2024 Fee On or After August 24, 2024 Student Registration Fee On or Before August 23, 2024 Fee On or After August 24, 2024 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
