Symposium by the Sea Attendee Registration Symposium by the Sea Attendee Registration "*" indicates required fields 1Personal Information2Registration Personal InformationAARC NumberName* First Last Credentials RRT CRT RRT-NPS RRT-ACCS RRT-SDS CRT-SDS RPFT CPFT RPSGT MD DO RN Student Other Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Enter Email Confirm Email Employment InformationFacility / School Job FunctionDirectorManager/Assistant ManagerEducation CoordinatorProgram DirectorDirector Clinical EducationSupervisor/Lead therapistStaff therapistSales / marketingStudentOtherIf other, identify your employment status or position. VSRC Board Position* President President-Elect Past President Vice President Secretary Treasurer Delegate Blue Ridge District Director Central District Director Tidewater District Director Northern District Director Western District Director Do you require any special accommodations or dietary restrictions?* No Yes Special Accommodations*Please identify special accommodations. RegistrationRegistration Fee*AARC Member 3 daysNon-AARC Member - all 3 daysStudent - AARC Member - all 3 daysStudent - non-AARC - all 3 daysAARC Member - Active Military Duty - all 3 daysAARC member 2 daysnon-aarc member 2 daysstudent aarc 2 daysstudent non-aarc 2daysactive duty 2 daysAARC member 1 dayNon AARC member 1 dayStudent AARC 1 dayStudent Non-AARC 1 dayActive Duty 1 dayDiscount CodeEvent staff and selected others may enter their discount code. Total Credit CardCard Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.
