Registration Form

Registration Form
BY WEB
(preferred method)
conferences.shrm.org/diversity
BY FAX*
Diversity & Inclusion Conference & Exposition
+1.703.535.6490
Credit card registration & government purchase orders
BY PHONE
October 25-27, 2016 | JW Marriott | Austin, Texas
800.283.7476, option 3
+1.703.548.3440 (Int’l), option 3
BY MAIL**
SHRM Diversity & Inclusion Conference & Exposition
P.O. Box 79482
Baltimore, MD 21279-0482
Check & government purchase orders
One registration form per registrant. Please print clearly.
**Please allow 4-6 weeks for processing.
SHRM Member Number
Job Title
M.I.
First Name
Business/Company
Last Name
Street Address
Name for Badge
City
Business Phone Number
Country
State/Province
Is this your
E-mail Address
Dates
Member*
Join Now
Nonmember
Apr 19 – Jul 29, 2016
Early Bird
$1,250.00
$1,430.00
$1,535.00
Jul 30 – Sep 30, 2016
Standard
$1,385.00
$1,565.00
$1,670.00
Oct 1 – 27, 2016
Late
$1,495.00
home or
ZIP
business address? The address listed above will be encoded in your bar code.
Payment is required at the time of registration in order to attend.
Please make all checks payable to SHRM in U.S. dollars drawn on a U.S. bank. All phone and faxed
registrations must be accompanied by a VISA, MasterCard or American Express number and signature.
Check enclosed
U.S. Government P.O. # (U.S. Gov’t agencies only)
Attach registration form to P.O.
$1,675.00
$1,780.00
I authorize SHRM to charge $________ to my:
American Express
VISA
MasterCard
Membership
*Join SHRM! This option includes both your one-year membership fee in SHRM at a special conference
rate of only $180 and your conference registration at the member rate. Note: Under IRC Section 162(e),
3% of the annual dues are allocable to lobbying expenses and are therefore not deductible.
Additional Education Opportunities
Credit Card #
Exp. Date
Signature
NAME AS IT APPEARS ON CREDIT CARD BILL
Start your learning experience early by attending a preconference offering.
Unconscious Bias & HR: A Theatrical Experience
Oct 24, 2016 | 4:30 p.m.–6:00 p.m.
Conflict to Clarity: Managing Employee Relations Issues
Oct 24, 2016 | 8:30 a.m.–5:00 p.m.
Member
Nonmember
$0.00
$0.00
$580.00
$580.00
One-Day Rates / Exposition Hall
One-Day Registration provides access to daytime and evening activities for a single day at the
conference.
Exposition Hall Pass provides access to the Exposition Hall for both days.
Tuesday One-Day Registration
Oct 25, 2016 | 8:00 a.m.–7:00 p.m.
$640.00
$920.00
Wednesday One-Day Registration
Oct 26, 2016 | 8:00 a.m.–5:00 p.m.
$640.00
$920.00
Thursday One-Day Registration
Oct 27, 2016 | 7:00 a.m.–1:00 p.m.
$495.00
$780.00
Exposition Hall Pass
October 25, 2016 | 4:00 p.m.–6:30 p.m.
October 26, 2016 | 9:30 a.m.–1:30 p.m.
$120.00
$120.00
Cancellation and Transfer Policy
• A cancellation must be in writing using our online form. Please visit http://conferences.shrm.org/diversity
to complete the online form.
• Confirmed registrants may cancel and receive a full refund minus a $250 administrative fee until July 29,
2016.
• Fifty percent (50%) of the registration fee will be refunded for cancellations received from July 30 through
September 30, 2016.
• Cancellations received after September 30, 2016, are nonrefundable.
• An additional cancellation fee of $75 will be charged for each conference add-on included in your
registration.
• If a SHRM member transfers his or her registration to a nonmember, the nonmember must pay the
difference of the SHRM member and nonmember price at the time of the transfer.
This policy is subject to change.
TOTAL FOR ALL SELECTIONS DUE $________________________________
16-0397
Cardholder’s Daytime Phone Number
Internal Use Only
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Source Code: DIV16WEB