2023 CONVENTION REGISTRATION FORM

Illinois Psychological Association 2023 Annual Convention

October 26 & 27, 2023

If paying by check, click here for a copy of the 2023 Registration Form to fill out and mail in, and to view after early bird pricing information. Otherwise, please fill out the form below.

Click here for a copy of the 2023 Convention Brochure.

Are you an IPA member?
Yes No

First Name

Middle Name or Initial (optional)

Last Name

Highest Degree

Organization/Affiliation

Address1

Address2

City

State

Zip

Phone

Email Address

SELECT REGISTRATION CHOICES

Register by September 29^th to receive EARLY BIRD pricing.

THURSDAY AND FRIDAY PROGRAMS (Includes Lunch)
Non-Members: $350

THURSDAY PROGRAMS ONLY (Includes Lunch)
Non-Members: $185
Students who are not IPA Members: $45

FRIDAY PROGRAMS ONLY (Includes Lunch)
Non-Members: $195
Students who are not IPA Members: (no lunch) $35
Students who are not IPA Members: (lunch included) $50

TOTAL DUE:

I prefer a vegetarian lunch

Credit Card Information

First Name on Credit Card

Last Name on Credit Card

Credit Card Number

Security Code

Expiration Month

Expiration Year

YOUR PROGRAM CHOICES: Check the number of each program you plan to attend on Thursday and Friday. This information will help determine meeting room size. Refer to program numbers listed with program titles.

Thursday: A.M. 1 2 3 4 5 6

Thursday: P.M. 7 8 9 10 11 12 13 14 15

Friday: A.M. 16 17 18 19

Friday: P.M. 20 21 22 23 24