SCMA 2019 Annual Conference & Expo Included Comp. Registration – August 21-23, 2019 "Finding a Path Through the Membrane Maze"Hilton Fort Worth - Fort Worth, TXWednesday, August 21, 2019 - Friday, August 23, 2019 RegistrantPlease refrain from using all caps/uppercase letters, please use sentence structure letter case.Salutation*Mr.Mrs.Ms.Dr.First Name*Middle InitialLast Name*Suffix (i.e.: Ph.D., P.E., Jr.)Job Title*Company*Address*City*State*Zip/Postal Code*Country*AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUSAUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweTelephone*Cell PhoneEmail*Enter registered attendee's email address Website Special NeedsFood Allergies (describe below)Gluten Free MealsPaleo MealsVegan MealsVegetarian MealsWheelchair AccessOther (describe below)Food AllergiesOther Special Needs Billing Contact InformationEnter billing contact information, if applicableBilling Contact Name First Last Billing Contact EmailEnter billing contact's email address Billing Contact Phone Please send copy of the invoice/receipt to Billing Contact Staying at Host HotelMake your lodging arrangements directly with the Hilton Fort Worth by clicking the link or by phone at 800-HILTONS. Refer to SCMA Annual for the discounted room rate negotiated for reservations made by July 25, 2019 (subject to availability).Will you be staying at the Host Hotel?*Yes, I will be staying at the host hotelNo, I will not be staying at the host hotelHow many nights will you be staying at the Host Hotel?* Annual Conference & Expo RegistrationRegistration and Payment must be received by event date.To receive the early registration rate, payment must be received on or before August 1, 2019.Today - Date Date Format: MM slash DD slash YYYY Event SponsorNetworking Event (Stockyard Maze) Sponsor, $2,500SOLD OUT - Bag Sponsor, $2,500Platinum Sponsor, $2,000Gold Sponsor, $1,500Silver Sponsor, $800Bronze Sponsor, $500SOLD OUT - Awards Sponsor, $600Trivia Prizes Sponsor, $350No SponsorshipExhibit SpaceTable Top Exhibit, $750 (Included 1 Full Attendee Registration)No ExhibitSpaces are selected onsite - first come, first served.Early RegistrationComp. Reg. for Exhibit/Sponsor (already purchased), $0Comp. Reg. for Host Facility, $0click here to apply for membership nowRegistration*Comp. Reg. for Exhibit/Sponsor (already purchased), $0Comp. Reg. for Host Facility, $0Non-Members - Contact SCMA if interested in joining prior to registering or click here to apply for membership now.Sponsorship Package: Your Choice*Exhibit Package (Includes 1 Attendee with Table-Top Exhibit)2 Full AttendeesIncluded in the sponsor fee.Are you the Attendee?*Yes, the same as aboveNo, different than above Company Description*100-word company descriptionUpload Company Logoplease provide a High Resolution, 300 DPI or greater Included Attendee 1Salutation - Included Attendee 1*Mr.Mrs.Ms.Dr.First Name - Included Attendee 1*Last Name - Included Attendee 1*Company - Included Attendee 1*Job Title - Included Attendee 1*Address - Included Attendee 1*City - Included Attendee 1*State - Included Attendee 1*Zip/Postal Code - Included Attendee 1*Country - Included Attendee 1*Telephone - Included Attendee 1*Email - Included Attendee 1* Included Registrant 2Salutation - Included Registrant 2*Mr.Mrs.Ms.Dr.First Name - Included Registrant 2*Last Name - Included Registrant 2*Company - Included Registrant 2*Job Title - Included Registrant 2*Address - Included Registrant 2*City - Included Registrant 2*State - Included Registrant 2*Zip/Postal Code - Included Registrant 2*Country - Included Registrant 2*Telephone - Included Registrant 2*Email - Included Registrant 2* Conference ActivitiesTrivia Contest and Networking Reception*Wednesday, Aug. 21, 4:00-5:00pmIncluded in registration feeYes, Attending Networking ReceptionNo, Not Attending ReceptionAwards Luncheon*Thursday, Aug. 22, 12:00-1:30pmIncluded in registration feeYes, Attending Awards LuncheonNo, Not Attending Awards LuncheonFacility Tour*Park Cities Water Treatment PlantThursday, Aug. 22, 1:30-4:30pmIncluded in registration fee.Yes, Attending the Facility TourNo, Not Facility TourNetworking Event*Stockyard MazeThursday, Aug. 22, 5:00-8:30pmIncluded in registration fee.Yes, Attending Networking EventNo, Not Attending Reception Guest TicketsGuest/Spouse Trivia Contest and Networking Reception (early rate)*Wednesday, Aug. 21, 4:00-5:00pmYes, Guest Attending Networking Reception, $40No, Guest not Attending Networking ReceptionGuest/Spouse Trivia Contest and Networking Reception*Wednesday, Aug. 21, 4:00-5:00pmYes, Guest Attending Networking Reception, $50No, Guest not Attending Networking ReceptionGuest/Spouse Awards Luncheon (early rate)*Thursday, Aug. 22, 12:00-1:30pmYes, Guest Attending Awards Luncheon, $50No, Guest not Attending Awards LuncheonGuest/Spouse Awards Luncheon*Thursday, Aug. 22, 12:00-1:30pmYes, Guest Attending Awards Luncheon, $60No, Guest not Attending Awards LuncheonGuest/Spouse Networking Event (early rate)*Stockyard MazeThursday, Aug. 22, 5:00-8:30pmYes, Guest Attending Networking Event, $40No, Guest not Attending Networking EventGuest/Spouse Networking Event*Stockyard MazeThursday, Aug. 22, 5:00-8:30pmYes, Guest Attending Networking Event, $50No, Guest not Attending Networking EventGuest Name* First Last Contact Hours AvailableNeed Contact Hours/PDHs Certification?*Yes, Contact Hours/PDHs Certification RequiredNo, Contact Hours/PDHs Certification Not RequiredIncluded in registration fee.License State*License Type*License Level*License #* Total Registration FeeTotal Registration Fee $0.00 Payment InformationPayment Method*Complimentary Registration Only - No Optional Items SelectedCredit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoice Comments/QuestionsComments Cancellations/RefundsWritten cancellation requests received by SCMA on or before August 1, 2019 will receive a refund, less a $50 processing fee. Full payment is required if cancellation is received on or after August 2, 2019 - no refunds and no credits for future events will be granted. However, substitutions may be made at any time. SCMA reserves the right to make changes in programs and speakers, or to cancel programs when conditions beyond its control prevail. Every effort will be made to contact each enrollee if a program is cancelled. If a program is not held, SCMA’s liability is limited to the refund of the program fee only. CAPTCHAPlease refer to SCMA’s Privacy Policy if you have any questions regarding your preferences.