BSF Online Conference Registration Form
Name
*
Address
*
(where you receive your credit/debit card statement)
Email Address
*
Phone Number
Tuition
SELECT
$229 - BSF Members registering by 1/5/19
$249 - BSF Members registering after 1/5/19
$259 - With new membership or renewal by 1/5
$279 - With new membership or renewal after 1/5
$279 - Non-members by 1/5
$299 - Non-members after 1/5
$109 - Students (degree-seeking, ID required) by 1/5
$125 - Students after 1/5
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
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