Connecticut Psychological Association Convention

24th Annual CPA Convention, November 12, 2010

Register here on-line for the 2010 Convention at the Hartford/Windsor Marriott, Friday, November 12. This site is on a SECURE ENCRYPTED SERVER and your credit card information is secure. If you prefer, you may print a registration form from the web (PDF format, requires free Adobe Acrobat Reader) and then mail or fax it to CPA. For easiest registration, complete this form and then click "SUBMIT."

Download the Ethnic Diversity Scholarship Application (PDF)

Please provide the following information:

Name (for badge)

Street address

Address (cont.)

City

State

Zip

Phone

FAX

E-mail

Are you attending a CPA Convention for the first time?

Yes
No

CPA complies completely with all requirements of ADA. If you require special accommodations in order to participate fully, please indicate here:

Yes, I require special accommodations (Please describe):

No, I do not require any special accommodations.

CPA membership status:

Member in good standing (dues paid for 2010)
Non-Member
Non-Member wishing to join now-Special Rate
Student Affiliate
Professional / Not eligible for CPA membership

These events are included. Please indicate which ones you plan to attend:

Continental Breakfast (7:30-8:30)
Annual Meeting (8:15-8:45)
Friday Lunch and Awards (11:55-1:50)
Legislative Network Reception (Friday 5:05-7:00 p.m.)

Please help us plan space requirements by indicating which sessions in each time block you plan to attend. You are not bound by these choices, it just allows us to be sure seating is adequate.

To see the Convention Programs and the corresponding numbers for the boxes below. Click here. (Requires Acrobat Reader)

Which sessions will you attend (for planning - you can change your mind!)?

8:45-10:00 (1 CE)
1 Keynote Address

10:25-11:55 (1.5 CE)
2 3 4 5 6

1:50 - 3:20 (1.5 CE)
7 8 9 10 11

3:35-5:05 (1.5 CE)
12 13 14 15 16

Convention Fee: Enter the amount based on the fee schedule below.

Find you fee here. Locate the appropriate fee in the table below and enter it above. This is the amount to be charged to your card.

All fees include Friday luncheon and social hour	Earliest Bird (By 8/23/10)	Early Bird (By 10/1/10)	After 10/1/10 or On-Site
CPA Member in good standing
Friday, November 12	139	149	159
Non-CPA Member
Friday, November 12	159	169	179
Non-Member Special: Save $50: Convention plus Membership through 12/31/11	189	189	199
Students: For $10 get membership through 2011
Friday, November 12	50	55	55
Student Affiliate Special: Convention plus Membership through 12/31/11	60	65	65
Professional (not CPA Eligible)
Friday, November 12	149	159	169

Payment options:
Please charge my fee to my credit card:

Credit Card
VISA MasterCard American Express

Enter your card number (no spaces or dashes):

3- or 4- digit security code (from back):

Expiration date (mo/yr, example: 12/10):

Cancellation Policy: If your request is received in writing before October 23, 2010 we will refund your meeting registration. A $35 administration fee will be applied. Fees can not be refunded for registrations cancelled on or after October 23, 2010.

Before clicking 'submit,' please check: Did you include card number?