BSF Online Conference Registration Form
Name
*
Address
*
(where you receive your credit/debit card statement)
Email Address
*
Phone Number
Tuition
SELECT
$229 - BSF member registering by 7/22
$249 - BSF member registering after 7/22
$259 - With new BSF membership or renewal by 7/22
$279 - With new BSF membership or renewal after 7/22
$279 - Non-members registering by 7/22
$299 - Non-members registering after 7/22
$109 - Students (degree seeking) registering by 7/22
$125 - Students (degree seeking) registering after 7/22
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 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