Incompass Michigan 2020 Leadership Conference Registration

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Join us virtually, July 27-31

Email *

Organization *

First and Last Name of Registrant #1 *

Email of Registrant #1 *

Current Physical Address of Registrant #1 to receive conference materials *

First and Last Name of Registrant #2

Email of Registrant #2

Current Physical Address of Registrant #2 to receive conference materials

First and Last Name of Registrant #3

Email of Registrant #3

Current Physical Address of Registrant #3 to receive conference materials

Names and Emails of Additional Registrants

Membership *

My Employer is an Incompass Michigan Member

I would like to join Incompass Michigan as an Individual VR Member and am employed by Michigan Rehabilitation Services or Michigan Bureau of Services for Blind Persons - $150 Annual Dues will be added to this invoice

Non Member

Name and Address to Invoice

Registration

Our annual Leadership Conference is valued at $400, however in response to the COVID-19 pandemic we are offering a special "pay as you are able" registration.

Suggested contribution of $150 per person.

A minimum contribution of $50 per person is requested for non-member registrations.

Invoice Amount *

$400 per registrant

$150 per registrant (suggested)

$50 per registrant

$0 per registrant (available for members only)

Other:

A copy of your responses will be emailed to the address you provided.

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