Immunize SD Conference Name(Required) First Last Title(Required)CredentialsEmail(Required) Organization(Required)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneLicense or Registration Number (Pharmacists/Technicians Only)Attendance Type(Required) General Attendee ($150) Student ($75) SD DOH Employee SponsorMailing ListUpon registering, you will automatically be enrolled to receive emails for all training opportunities. Please indicate below if you would NOT like to be notified of future trainings.Photo ReleaseI hereby give my permission to Immunize South Dakota to use any photos taken during the ISD Conference and any ISD hosted social functions. The photos will be used for the ISD Newsletter and social media. I agree I do NOT agreeCredit CardCardholder NameCard DetailsTotal Cancellation Policy(Required)No Registration will be final until payment is received. All cancellations must be confirmed in writing and must be received by ISD administration by July 31 2022. Cancellations received on or before the July 31 deadline will be assessed a $25 processing fee. Cancellations received after July 31 are not refundable. No Shows are not refundable - no exceptions. Please allow two to three weeks following the conclusion of the conference for refund processing. No refunds will be processed prior to the conference. I have read and understand the cancellation policy
