Region VI AAPI Health Summit Registration Form

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(Event details are below)

ATTENTION: WE ARE AT FULL CAPACITY, SO ONLINE REGISTRATION FOR IN-PERSON ADMISSION ARE CLOSED. YOU CAN STILL REGISTER FOR VIRTUAL ADMISISON ($10 ticket).

Please fill out the registration questions below, then use the Paypal link (provided when you submit this form) to purchase the ticket.

For sponsors, remember to add your PROMO Code for complimentary registration (different levels of support will include different number of complimentary registration spots). PROMO Code will be provided to you after you complete the Sponsorship Form.

If you or your organization would like to be a sponsor for the summit, please go to this link: Sponsorship Form

To promote an environmentally friendly summit, participants are encouraged to bring their own water bottle which can be filled at the summit.

Email *

Your First and Last Name *

Your title

Your Company/Affiliation's Name

Your phone number *

Please select which ticket(s) you'll purchase *

SOLD OUT- $35 for full conference (same price for one or two days)

SOLD OUT-$20 for students (If selected, please list name of school/university in the next question)

$10 for virtual participation (Link will be sent to you)

I have a PROMO CODE (If you are with a group that is a sponsor, please insert PROMO code in the next question)

Other:

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