Immunize SD Conference Name(Required) First Last CredentialsTitle(Required)Organization(Required)Email(Required) PhoneAddress(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 License or Registration Number (Pharmacists/Technicians Only)Attendance Type(Required) General Attendee - $200 VIRTUAL General Attendee - $100 PHN General Attendee Student Rate - $75 VIRTUAL Student Rate - $50 Coupon Mailing 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 agree Credit Card Cardholder Name Card Details Total 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 March 30, 2026. Cancellations received on or before the March 30 deadline will be assessed a $25 processing fee. Cancellations received after March 30 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
