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Registration form

NYSAPLS Spring Workshops 2022
Register online today at www.nysapls.org or complete the form below and submit with payment by mail
NAME:_____________________________________________________________________________________________

ORGANIZATION: __________________________________________________________________________________

ADDRESS: _________________________________________________________________________________________
CITY: _________________________________________________________STATE: __________ ZIP: ______________
(this is my *home/*work address)

WORK PHONE: _______________________________ HOME PHONE: __________________________________
E-MAIL: _________________________________________________________________

NYS LS LICENSE NUMBER: _____________________________________________________ Register Online!
Save time &
Workshop fees: www.nysapls.org
Fee includes instruction, digital handouts, lunch and morning/afternoon refreshments.

NYSAPLS Members NYSAPLS Members Non-Members
(Licensed) (Non-licensed)

 “Early Bird” Registration*: $249  “Early Bird” Registration*: $199  “Early Bird” Registration*: $349
 Regular Rate: $299  Regular Rate: $249  Regular Rate: $399
* To qualify for “Early Bird” registration rates, your payment must be received 30 days prior to the event date.
(By March 30th – Fishkill; by April 4th – Webster)
Choose location:  April 20 – Fishkill, NY  May 4 – Webster, NY NYSAPLS Mask Policy:**
New York is currently experiencing
Payment Options: a significant increase in Coronavirus
 Check enclosed (make payable to NYSAPLS Inc.) infections. The CDC currently recommends
that fully vaccinated people can further
 Credit card __ MC __ Visa __ Amex __ Discover reduce their risk of becoming infected with
the Delta variant and transmitting it to
Credit card number: _____________________________________________________ others by wearing a mask in public indoor
settings in areas of substantial or high
Exp. Date: ___/___ Security Code: __________ community transmission. In an abundance
of caution, NYSAPLS has decided to
Signature: _____________________________________________________________ follow the CDC recommendations at our
event. Therefore, wearing a mask over your
Billing Address: _________________________________________________________ nose and mouth will be mandatory for all
attendees and staff. Disposable masks will
Mail this form to: NYSAPLS, 146 Washington Avenue, Albany, NY 12210 be provided at the event if you do not have
your own.
Questions?
Please call, (518) 432-4046 • Fax (518) 432-4055 or email, info@nysapls.org ** Subject to change with current guidelines
as of event date.
NEW! Option to Protect Your Registration*
We now offer cancellation insurance through Allianz Global Assistance, a third party provider. The insurance is ONLY available by registering
for this event on our website with a credit card payment. Register online at www.nysapls.org for more details.
NYSAPLS Cancellation Policy:
Payment must be made in full upon registration. Purchase orders not accepted. Cancellations submitted in writing 30 days or more prior to
the event, will be granted a 100% refund, less a 10% processing fee. After the 30 day window, I understand that my event ticket purchase is
intended to hold my reservation. Therefore, 0-29 days prior to the event, registration fees are non-refundable unless I obtain the cancellation
insurance provided by Allianz Global Assistance, a third party provider, during checkout. Register online at www.nysapls.org for more details.
In accordance with Title III of the Americans with Disabilities Act, we invite all registrants to advise us of any disability and any requests for
accommodations to that disability. If you have any questions, please call the NYSAPLS office at 518-432-4046.
By submitting this form, I acknowledge the cancellation policy above and understand I do not have an option to obtain cancellation insurance.
*Signature: _________________________________________________________________________________________________________
EMPIRE STATE SURVEYOR / VOL. 58• NO 1/ 2022 • JANUARY/FEBRUARY 27