Registration for Check or Cash Payment

Complete this form to pay for conference registration or CEUs via check or cash payment.

If you would like to pay via PayPal, click HERE

Name

Enter your name as you want it to appear on your nametag.

First Name

Last Name

Affiliation

Conference Registration

Platinum Sustaining Member ($325)

Gold Sustaining Member ($275)

Silver Sustaining Member ($225)

Bronze Sustaining Member ($175)

Regular Registration ($125)

Student Registration ($50)

Do you want to purchase a CEU Package (add-on)?

Payment Type

I will send a check payable to SEABA c/o Karen Anderson, WVU – Dept. of Psychology, P.O. Box 6040, Morgantown, WV 26506

I will pay via check at the conference

I will pay via cash at the conference