Credit Card Test Registration Registration form for CELA 2020 Conference.Terms & ConditionsBy registering for and/or attending the 2021 CELA Annual Conference, to be held in a virtual format, all participants agree to be bound by, and comply with, these Terms and Conditions. It is the participant's responsibility to read and understand these Terms and Conditions.FeesThe meeting registration fees includes all educational sessions and networking opportunities offered from Wednesday, March 17, 2021 through Friday, March 19, 2021. All meeting content will be available online until May 2021.Early Bird Registration - through February 1, 2021Regular – February 2, 2021 through March 1, 2021Late – March 1, 2021 through March 17, 2021Students*Please note: Students must have a valid Student ID at the time of the virtual meetingOrganization/Company*Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Conference Registration Type*Member RegistrationNon-member RegistrationStudent RegistrationNon-Presenting StudentNon-Presenting EmeritusTotal $0.00 Credit CardAmerican ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name RefundsNovember 2, 2020- February 2, 2021 - Refund minus $75 administrative feeFebruary 3, 2021- March 3, 2021 - 50% refundAfter March 3, 2021 - Substitutions onlyNo refunds or credits will be given to “no shows”.Cancellations & SubstitutionsConference registration can be cancelled only in writing. Email is preferred, though Mail or Fax are also acceptable.Email: firstname.lastname@example.orgCELA, 110 Horizon Drive, Ste 210, Raleigh, NC 27615Fax: 919-459-2074ReleaseRegistration and participation in the CELA 2021 Annual Conference, constitutes an agreement by the registrant to CELA’s use and distribution (both now and in the future) of the registrant or attendee's image or voice in photographs, videos, electronic reproductions and audio recordings of such events and activities.Global Investiture FundSome of your registration dollars will go towards The CELA Global Investiture Fund, in which The CELA will identify and develop practices which positively impact global conditions and align with The CELA organization’s vision and mission.QuestionsYou can also print it and fill it out, and send it to The CELA Office: 110 Horizon Drive, Suite 210, Raleigh, NC 27615.For questions about payment, contact CELA Staff at email@example.com or 919-674-4185. For questions about logistics or the event, contact Melissa Haycock, The CELA Conference Manager, at firstname.lastname@example.org or 919-459-6087.