28th Annual Mid-South Psychology Conference Registration

Saturday, April 5, 2025

Registration is $20.00 on or before March 28, 2025
and $25.00 after March 28, 2025 or at the door.

$0

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Name Name Title First Middle Last Suffix
Preferred Name on Name Badge
With what university are you affiliated?
Are you currently enrolled in ERMAS at CBU?

Are you currently enrolled in ERMAS at CBU? Yes No
Phone Phone - ### - ### ####
Email
Sex

Sex Male Female Other
Permanent Address Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
School Address, if different from above School Address, if different from above
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Would you like a T-Shirt for $15.00?
PHOTO HERE (opens in separate window)
Orders must be placed by Friday, March 21.
Pick up at check-in on conference day.

Would you like a T-Shirt for $15.00?
PHOTO HERE (opens in separate window)
Orders must be placed by Friday, March 21.
Pick up at check-in on conference day. Yes No
T-Shirt Size
$0

Total