2017 HNSA Conference RegistrationSeptember 26-2940 Patriots Point Rd, Mt. Pleasant, SC 29464 Step 1 of 5 - Terms & Conditions 0% Cancellation & Refund PoliciesPLEASE NOTE: AMEX & Discover not accepted online. Please call Jess Steinberg at 843-881-5924 to register if using these cards. Cancellation Policy: No registrant substitutions are permitted Registrations cancelled more than 60 days before the event will be refunded 70% of the registration fees Registrations cancelled less than 60 days but more than 30 days before the event will be refunded 50% of the registration fees Registrations cancelled less than 30 days before the event will not be eligible for a refund. Refund Policy: For payments received by credit or debit cards, the same credit/debit card will be refunded Required AuthorizationsAgreement to Cancellation/Refund Policy* I agree to the cancellation & refund policy above. Agreement to Credit Card Authorization* I hereby authorize the USS Yorktown Foundation to apply all charges for services rendered to the company/registrant on my credit card. Date Confirmation NumberName* First Last Name Tag*Your name as you would like it to appear on your name tagOrganization/Ship:*Email* Phone*Section BreakAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Arrival Date* Departure Date* Hotel where you plan to stay?*Emergency Contact Information* First Last Please provide us with your emergency point of contactRelation to you:*SpouseParentChildOtherEmergency Contact Phone Number*Emergency Contact Email HNSA Full Conference Early BirdHNSA Early Bird Price $350HNSA FFull Conference RegistrationHNSA Full Conference $375Are you bringing any companions?*YesNoCompanions - Max (4)Companion Early Bird Price: $150.00 Companion Regular Rate Price: $180.00 Companions at Early Bird Pricing (max. 4)?*Please enter a value between 1 and 4.Companions Regular Rate (max. 4)?*Please enter a value between 1 and 4.First Companion Name*Second Companion Name*Third Companion*Fourth Companion*Total $0.00 If you are having issues with your credit card processing online, you may call in and have your registration processed over the phone. AMEX card holders will need to call in to have use their cards for registration. Please contact Jessica Steinberg at (843)881-5924 or via email at email@example.comCredit Card* MasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.