Attendee Registration Form
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Please complete the registration information below.

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* Required Field(s)  
Name *
Email *
Title *
Fax *
Company Name *

Company Address *
City *
State *
Zip *
Work Phone *
Cell Phone *
Payment Amount*  $
Name of Individual or Company Making Payment*  $
  HR     Payroll  
Professional Designation   CPP     CPA     FPC   Other    
Are you a member of National APA? Yes    No  
Are you a member of Local Chapter of APA? Yes    No  
Chapter Name*
Special dietary needs Yes    No  
If yes, please specify

2011 Prices - No Refunds After September 17, 2011
Member Non-Member
Early Bird, until May 31 $395.00 $445.00
Jun 01 - Jun 15 $395.00 $445.00
After Jun 16 $545.00 $595.00
Are you a member? Yes No
 
I will attend the Thursday October 20, 2011 Conference Theme Event - included in the registration price.
Yes    No  
I understand that each dinner guest is an additional cost of $45.00 (Non-Refundable). I will be bringing guest(s) and have enclosed an additional $.

Make checks payable to "Midwest Regional Payroll Conference Org"     
Return check and registration to: Midwest Regional Payroll Conference Org                
P.O.BOX 7332 SHAWNEE MISSION, KS 66207-0332 

A WORKSHOP SESSION SCHEDULE WILL BE SENT TO YOU WHEN IT IS FINALIZED VIA EMAIL. PLEASE MAKE YOUR WORKSHOP SELECTIONS AT THAT TIME BY SUBMITTING THIS APPLICATION WILL SECURE YOUR PLACE AT THE CONFERENCE.

Contact Chateau on the Lake Resort Spa & Convention Center at 1-888-333-5253. Hotel reservations may be made directly online by clicking on the following link: http://booking.ihotelier.com/istay/istay.jsp?hotelID=11529&userType=GRP. Enter code 082211mrpc in the box designated attendee code. All reservations must be accompanied by a first night room deposit on or before September 17, 2011. There are a limited number of rooms at this special rate, please be sure to book your reservation early.  A special room rate of $135.00 per night for a Mountainview/Lakeview room; $187.00 per night for a Lake Front King room; $244 per night for an Ambassador Suite Mountainview room; and $294 for an Ambassador Suite Lakefront room. Rooms at the Chateau on the Late Resort Spa & Convention Center WILL book up fast; don't be left out. Based on availability, this special room rate will be extended to attendees who choose to stay at the resort over the weekend. 
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