New Mexico 46th Annual Conference on Aging - Registration

New Mexico 46th Annual Conference on Aging

Please provide the following information before proceeding with registration:

First Name: *

Last Name: *

Email: *

If you do not have an email address click here.

Organization Name:

Job Title:

Mailing Address: *

City: *

US State: *

Zip / Postal Code: *

Phone: *

I am planning on attending The Dance Monday, September 30th at the Convention Center from 6:00-9:00pm: *

Yes

Are you a sponsor? Select Yes to make a sponsor payment by credit card:

Are you a Service Provider?

Yes

Release Form

I, agree to allow The New Mexico Aging and Long-Term Services Department to release my name, address, and email address to exhibitors/sponsors and/or workshop presenters.

I hereby release, discharge, and exonerate the New Mexico Aging & Long-Term Services Department from any and all liability of every nature and kind arising out of the furnishing, inspection, and use of all released documents, records and other information, and this release shall be binding on assignees.

Please check one box:

I agree to the following terms:

I don't agree to the following terms:

CEU Credit Tracking

The cost of CEU credit this year is $55.

Need assistance with checking out? Once you complete the registration process you will be directed to Authorize.net’s secure payment page for fee based tickets.

If you need assistance with paying with a Purchase Order, please email us at altsd.coa@altsd.nm.gov.

Select your ticket. Once you complete the registration process, you will be redirected to Authorize.net's secure payment page for fee-based tickets:

	Required Ticket* You must select one ticket from this section before continuing.	Price
	Age 55+ Seniors/Family Caregivers	$12.00
	Senior Service Providers	$35.00

	Add-on Ticket(s) Select as many tickets as you'd like below.	Price
	CEU Credit	$40.00

Total: 0

* required