Register for the Conference

Below is the registration form for the Annual leadership conference. Please fill out all fields, before submitting the form. Due to the high volume of registrations we receive,
there may be up to a five day delay in receiving your confirmation. If you have not received confirmation, after one week, please email the Academy, and we will verify your
registration form was received.

Please do not call for payment, until you receive the email confirmation.

All active conference sponsors are listed in the pull down menu. If your organization is not listed, then you should select the standard rate.

Thank you for your support of the Chair Academy Conference.

Pre-Conference Skill-Building Workshops (Select only ONE)		Pre-Conference Skill-Building Workshops March 28, 2017 Full Day - $125.00 9:00 am to 3:00 pm This fee includes: coffee and juice in the morning, AM refreshment break, and materials
	None
$125	The Trick to Being a Chair or Organizational Leader
$125	The Piloted Self: Flying Leadership to New Heights
$125	Strategic Preparedness: New Think Leadership Team
$125	Strengths Strategy - Applying Strengths to Work and Life
$125
To read the abbreviated session summary, please hover over the session title. To read full session summary, please click on the session title. (You will be directed away from the registration page)

Conference Registration Costs (Select only ONE)				Full Conference Attendance Will Include: Coffee Service - Each Day Two - AM Breaks Two - PM Breaks Hot Breakfast on the 28th, 29th, and 30th Welcome Reception Hors d'oeuvres (March 28, 2016) Access to ALL General Sessions Access to ALL Break-Out Sessions Complimentary 20 or 50 minute Strengths Coaching Session at the Strengths Cafe, presented by Strengths Strategy
Full Conference Rates - March 29-31, 2017 (Pre-Conference Workshops are not included in these rates.)
		$800.00	ONSITE Conference Rate (March 28-31, 2017)
		$700.00	Standard Conference Rate (March 10 - March 27, 2017)
		$600.00	Early-Bird Conference Rate (November 1 - March 5, 2017) - EXPIRED
		$500.00	Legacy Conference Rate (July 12 - October 31, 2016) - EXPIRED
		$500.00	Conference Sponsor/Conference Host/Academy Facilitator You must select your Organization from the list below, to receive this rate.

		$600.00	Academy Member/Conference Presenter Rate You must have a PAID, Active, Membership at the time of registration ----- There is no Discount Code for Presenters. Just select the rate.-----

	Discount Code
	Single Day Conference Rates - March 29 and 30 only
		$300.00	Wednesday, March 29, 2017 only. Includes all events for this day only. Two general sessions, two break-out sessions, breakfast, and am/pm breaks
		$300.00	Thursday, March 30, 2017 only. Includes all events for this day only. Two general sessions, two break-out sessions, breakfast, and am/pm breaks

Participant Information (All fields mandatory)

Full Name:
Nick Names are allowed.

Title/Position:

College:

Address:

City:

State/Province:

Postal/Zip code:

Country:

Email:

Verify Email:

Phone:

Fax:

Dietary
Restrictions:

Please check this box if you are a Vegetarian

Please check this box if you have a Gluten Allergy

Special, more restrictive diets, should be addressed
with the Conference Hotel, they will endeavor to work with you.

Additional personal charges may apply.

Executive Assistant Name:

Executive Assistant Email:

Executive Assistant Phone:

Emergency Contact Information

Full Name:

Email Address:

Phone:

WERE YOU REFERRED BY A COLLEAGUE?
Tell us who referred you, and we will reward their support.

Referee's Name:

Referee's Email:

	Cancellation Policy
	Notification of cancellation before the conference	Cancellation Fee
	After 03/07/2017	$250
	No Notification/No Show	Full Registration Fee Cost
	An invoice and confirmation email will be sent to you within 5 business days. Do not contact the Chair Academy until you receive the confirmation email with your invoice. Payments must be received IN FULL, prior to the Conference. Any and all cancellations MUST be submitted to the Chair Academy, in writing, via email, BEFORE 03/07/2017. Checks are the preferred method of payment, but credit cards are accepted. We currently DO NOT have online payment capabilities. Credit Card payments can be made/processed on Wednesdays, during business hours.
	Please read the following conditions and sign below.
	If you need to completely cancel your registration, it is your responsibility to contact the Chair Academy in writing to do so. Contact the Chair Academy at conference@chairacademy.com The Chair Academy will contact you to confirm any cancellation we receive. If the Chair Academy is not notified in writing of your cancellation and you do not attend, you will be charged the full amount. Your photo may be taken during the events being held at conference. Your image may be used in future Chair Academy promotional materials. This includes website, flyers, social media, and any other media format. The Chair Academy is committed to complying to the provisions, of Title II, of the Americans with Disabilities Act. We ask that requests, for any special needs, be submitted to us within a reasonable timeframe (60 days, if possible), to make appropriate arrangements. By signing/submitting this form you have read and agree to the photo and cancellation policy.
	Please type your name in the field below to agree to the above conditions.
	Please answer this simple security question... What is the third word from this list? Airplane, textbook, next, plum