BSF Online Conference Registration Form
Name
*
Address
*
(where you receive your credit/debit card statement)
Email Address
*
Phone Number
Tuition
SELECT
$239 - BSF Members registering by 9/21/19
$259 - BSF Members registering after 9/21/19
$269 - With new membership or renewal by 9/21/19
$289 - With new membership or renewal after 9/21/19
$289 - Non-members by 9/21/19
$299 - Non-members after 9/21/19
$125 - Students (degree-seeking, ID required) by 9/21/19
$135 - Students after 9/21/19
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