PASIC 2024 Indiana Resident Registration

PASIC 2024
Indiana Resident Registration

Registration Type:

4-Day BadgeSaturday Badge1-Day Expo Hall Wristband

Number of Attendees:

Please choose the day you'd like
to visit the Expo Hall:

Thursday, November 14Friday, November 15Saturday, November 16

Primary Registrant Information

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

Phone

Additional Registrant Information

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

First Name

Middle Name

Last Name

Pronouns

Pronouns (Other)

School/Company to display
on badge (if applicable)

Primary Mailing Address

Address

City

State

Postal Code

Cancellation Policy

I have read and agree to the following cancellation policy: All cancellations must take place on or before October 31, 2024, and will incur a $50 cancellation fee. NO REFUNDS will be offered after this date.

These registration options are only available for Indiana residents.

Contact Information