2019 OTAH Annual Conference Registration
*If paying ONLINE, your registration is NOT complete until OTAH receives this form via mail or email*
Last Name *
Your answer
First Name *
Your answer
Title *
Address
Your answer
Phone number (work, cell, home)
Your answer
Email *
Your answer
Place of employment *
Your answer
Select only ONE track *
Registration Fee (Select only ONE) *
Additional Late Fee *
Handouts (select ONE option) *
Is your OTAH membership current for July 1, 2019-June 30, 2020? *
Email provided to vendors *
How are you paying for conference? *
Additional important instructions/information
1. No P.O. or credit cards accepted by MAIL
2. Payment by check: To - Occupational Therapy Association of Hawaii
Mail to: OTAH Annual State Conference
1360 S. Beretania St. Suite 301
Honolulu, HI 96814
3. Please write SEPARATE checks for:
a) membership dues
b) conference registration
c) political action contribution
4. NEW online payment now available for:
a) Conference fee(s) at: https://otaohconference.securepayments.cardpointe.com/pay
b) Membership dues at: https://otaofhawaii.securepayments.cardpointe.com/pay
5. Returned checks will be assessed a $30 fee
6. Cancellation policy:
a) 100% total registration refund if notice given by Sept 28, 2019 by phone or email
b) 50% total registration refund if notice given Sept 29-Oct 5, 2019
c) No refund if notice given after Oct 5. 2019.
7. You will receive an email confirmation once BOTH payment AND registration complete
I confirm that the above is correct *
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