Registration

PIRSA State Workshop Registration
Friday, October 28th, 2022 at Bucknell University

1. Complete Registration Form (left column)
2. Complete payment via information in the right column.

Registration Form

Please enter your information as it should appear on your name badge.

* Indicates required field

Name *

First

Last

Email *

Title *

Institution/Organization *

* Late Fee will be applied for registration forms received after October 21st, 2022 *

Do you plan on attending the PIRSA Social on Thursday (10/27) evening? *

Registration Fee *

Would you be interested in playing a round of golf on Thursday (10/27)? (Approx. tee time - 4:00pm) *

How did you hear about the PIRSA State Workshop? *

Dietary Restrictions/Comments/Requests *

Submit

State Workshop Registration Payment

Mail check payments (made out to PIRSA) to:
Daniel Comas, PIRSA Treasurer
West Chester University
Student Recreation Center
275 N. Campus Drive
West Chester, PA 19383

If you require an invoice please contact:
Daniel Comas, PIRSA Treasurer
E-mail - [email protected]
Phone - (610) 436-2277
.
Click below to pay via Credit Card via PayPal.

PIRSA State Workshop Registration
Friday, October 28th, 2022 at Bucknell University

Registration Form

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PIRSA State Workshop RegistrationFriday, October 28th, 2022 at Bucknell University

Registration Form

Home

About

Services

Payments

Contact

PIRSA State Workshop Registration
Friday, October 28th, 2022 at Bucknell University