Conference Registration 2019 Conference Registration Form You will be contacted directly if a registration fee is required.Member-Entities are eligible for one full scholarship*. Dual Trust Member-Entities are eligible for two full scholarships. A limited number of additional scholarships are available upon approval. * A full scholarship, for members only, includes registration, two hotel nights, breakfasts, lunch, reception/dinner, and mileage/tolls/parking reimbursement. Board of Trustees are eligible for one full scholarship in addition to the above. Agents of current PennPRIME Members are eligible for one complimentary registration. Gold Sponsors are eligible for two complimentary registrations. Silver Sponsors are eligible for one complimentary registration.Name* First Last Nickname for Badge Title* Municipal Entity/Organization* Email Address* Phone*Special Dietary Needs (please specify)Accessibility Needs (please specify)Emergency Contact Name Emergency Contact PhoneTo assist us in keeping expenses down, please respond with your commitment to the meals you plan to attend below (select all that apply).Please check all meals you will be attending Select All Thursday Breakfast Thursday Luncheon Thursday Reception/Dinner Friday Breakfast Δ Back to Conference Section