Registration: Hazing Prevention Institute

Registration: Hazing Prevention Institute

If you have questions before completing registration, please contact Todd Shelton, Executive Director.

Registration is open until May 22 or until capacity is reached. Attendance is capped at 100 participants to provide the optimum educational experience.

Groups: Both individuals and teams are encouraged to participate. We encourage institutions to send individuals from different departments or parts of your campus community (recreation, athletics, fraternity/sorority life, performing arts, etc.). A discount is available to groups of four or more (You may register up to six at a time using this form.)

Before you register, make sure you have the following information for each individual you will be registering:

• Name
• Email
• Cell Phone
• Job title/role
• Accessibility needs, allergies and/or dietary needs
• Tshirt size

Tell us about first person being registered:

If you are registering additional people, you will provide their information further down in the form. (You may register up to six individuals using this form.)

Name *

First

Last

Email *

Cell Phone *

Institution/Organization *

Job Title or Volunteer Role *

Pronouns

Accessibility needs, allergies and/or dietary needs

Tshirt Size (Unisex) *Please selectSmall (S)Medium (M)Large (L)Extra-Large (XL)Double Extra-Large (2XL)

How many individuals are you registering?

(You may register up to six individuals using this form.)

Registration(s) *One individual (1 x $379) - $379.00Two individuals (2 x $379) - $758.00Three individuals (3 x $379) - $1,137.00Four individuals (4 x $329) - $1,316.00Five individuals (5 x $329) - $1,645.00Six individuals (6 x $329) - $1,974.00Seven individuals (7 x $329) - $2,303.00

Note: Four or more registrations are calculated at the discounted rate of $329/person.

Now provide information for the additional people you are registering

Name, Person 2 *

First

Last

Email, Person 2 *

Title/Role, Person 2 *

Pronouns, Person 2

Accessibility needs, allergies and/or dietary needs for Person 2

Tshirt Size (Unisex), Person 2 *Please selectSmall (S)Medium (M)Large (L)Extra-Large (XL)Double Extra-Large (2XL)

Name, Person 3 *

First

Last

Email, Person 3 *

Title/Role, Person 3 *

Pronouns, Person 3

Accessibility needs, allergies and/or dietary needs for Person 3

Tshirt Size (Unisex), Person 3 *Please selectSmall (S)Medium (M)Large (L)Extra-Large (XL)Double Extra-Large (2XL)

Name, Person 4 *

First

Last

Email, Person 4 *

Title/Role, Person 4 *

Pronouns, Person 4

Accessibility needs, allergies and/or dietary needs for Person 4

Tshirt Size (Unisex), Person 4 *Please selectSmall (S)Medium (M)Large (L)Extra-Large (XL)Double Extra-Large (2XL)

Name, Person 5 *

First

Last

Email, Person 5 *

Title/Role, Person 5 *

Pronouns, Person 5

Accessibility needs, allergies and/or dietary needs for Person 5

Tshirt Size (Unisex), Person 5 *Please selectSmall (S)Medium (M)Large (L)Extra-Large (XL)Double Extra-Large (2XL)

Name, Person 6 *

First

Last

Email, Person 6 *

Title/Role, Person 6 *

Pronouns, Person 6

Accessibility needs, allergies and/or dietary needs for Person 6

Tshirt Size (Unisex), Person 6 *Please selectSmall (S)Medium (M)Large (L)Extra-Large (XL)Double Extra-Large (2XL)

Name, Person 7 *

First

Last

Email, Person 7 *

Title/Role, Person 7 *

Pronouns, Person 7

Accessibility needs, allergies and/or dietary needs for Person 7

Tshirt Size (Unisex), Person 7 *Please selectSmall (S)Medium (M)Large (L)Extra-Large (XL)Double Extra-Large (2XL)

Complete Payment

Provide credit card information below to complete payment.

If you are required to pay by check, submit form without providing credit card information and mail check for the total amounted listed below to:

Hazing Prevention Network
11722 Allisonville Road, Ste 103, Box 355
Fishers IN 46038

Registrations will not be confirmed until payment is received.

Total Due:

Total

$0.00

Credit Card Information

Card

Name on Card

Comments (if needed)

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