AFC Region III and Facilities Commission 

Spring Collaboration Conference 2017 Registration

Type of Registration

Please select... Member Registration $50 Non-Member Registration $50 Retiree Registration $40 I'm a Sponsor!

First Name

Last Name

Title/Position

Institution

Please select... AFC Tallahassee Broward College Chipola College College of Central Florida Daytona State College Eastern Florida State College Florida Gateway College Florida Keys Community College Florida SouthWestern State College Florida State College at Jacksonville Gulf Coast State College Hillsborough Community College Indian River State College Lake-Sumter State College Miami Dade College North Florida Community College Northwest Florida State College Palm Beach State College Pasco-Hernando State College Pensacola State College Polk State College Santa Fe College Seminole State College of Florida South Florida State College St. Johns River State College St. Petersburg College State College of Florida, Manatee-Sarasota Tallahassee Community College Valencia College Other

Business/Company Name

Please specify your registration:

Region III Member AttendeeFacilities Commission MemberBoth (Region III & Facilities)

Contact Information

Email

Phone

Address Line 1

Address Line 2

City

State

Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

Postal Code

Dietary Restrictions

Sponsorship Level

Bronze $250: Program Ad, FlyersSilver $500: All of the above + 1 Vendor Table (includes 1 conference registration)Gold $750: All of the above + Brief Presentation (includes 2 conference registrations)Platinum $1000: All of the Above + Breakout Session (includes 4 conference registrations) Door Prize

Additional registration is included with this sponsor level - Please enter name(s) of additional attendees:

Please provide a brief description of your door prize and it's estimated value.