BSF Online Conference Registration Form
Name
*
Address
*
(where you receive your credit/debit card statement)
Email Address
*
Phone Number
Tuition
SELECT
$250 - BSF members
$280 - BSF members with membership renewal
$280 - Non-members
$120 - Students BSF members
$140 - Students - non-members (degree-seeking, ID required)
Credit card:
*
SELECT
Visa
MasterCard
Credit card number:
*
Expiration date:
*
CVV2 (3 digit):
**
Name as it appears on credit card:
*
Amount authorized:
*
$
By pressing submit below I authorize AAPB or the Biofeedback Society of Florida, Inc. to charge my credit card the amount indicated above.
*
required field
**
CVV2 is a required 3 digit security number on back of card
Credit Card Information submitted is secured by Brac Informatics Centre
Brac Informatics Centre is secured by Veri-sign