In order to complete your registration for the symposium, please 
	  fill out the form below.  
- After you submit the form, you will be directed to  page where you can pay the registration fee. 
- For questions regarding symposium registration, please contact: Registration
 
          
        Registration Form
        Required information is marked with * | 
    
     
      | 
	  Name and affiliation | 
        
 
      *First name:  | 
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      Middle name:  | 
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        | 
    
     
      *Last name:   | 
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        | 
    
     
      *Affiliation:  | 
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        | 
    
         
      |   Your name as you would like it to appear on the name badge: * 
          
          | 
    
     
      Your area of interest, as you would like it to appear on your badge:  
      (e.g., safety, web usability, physical ergonomics, etc.) *  
          
          | 
    
     
      Address  | 
        | 
    
     
      |   *Address line1:  | 
       
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      |   Address line2:  | 
      
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      |   *City, State, Zip:  | 
       
        
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      |   *Email:  | 
       
        
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      Dietary Needs  | 
        | 
    
     
      |   Please indicate:  | 
       
         Vegetarian, vegan, gluten free, etc  | 
    
     
      |   *National HFES Membership: 
         
		
        Not a member 
        
        Member 
        
        Student Affiliate Member
	  
	  *Symposium Fees:  $77 for 
	  standard registration and $31 for students 
	   (add $5 for paypal/credit card on the day, 
	  onsite registration) 
	  
	  - 
	  registration payment is your next step: PayPal(+$2) or Check 
	  
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      |   
          Terms of Agreement 
         
           The occurrence of this symposium is subject to acts of 
            God, war, government regulation, disaster, strikes, civil disorder, 
            curtailment of transportation facilities or any other emergency making 
            it impossible to hold the symposium. In the event of such occurrences, 
            every effort will be made to issue a refund, however there is no guarantee of one. Symposium schedule is subject to change. 
          
         
           
        
	          
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