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Company Information

* Required fields
*Company Name:
*Address
*City
*State
*ZIP Code
*Email
*Phone

Conference Registration
Full day, includes Awards Luncheon.
Early
Bird
After
9/21
Member (SDSC/SHRM/CASD) $235 $260
Nonmember $280 $305
Each attendee after first three $160 $160
Are you a member? YES     NO

Conference Attendees
Attendee Name Email
1:
2:
3:
4:
5:
6:

Additional Luncheon Tickets
Includes admission to Awards Luncheon.
Choose how many $35 $40

Payment Information
Card Type:
Name on Card:
Card Number:
Card Expiration: Month     Year

Card Authorization
By submiting this form, you authorize South Dakota Safety Council to charge the
included credit card for the selected items above.

I certify that my organization is tax exempt.
SubTotal $
Tax $
Total $



Contact the South Dakota Safety Council at sdsc@southdakotasafetycouncil.org
or phone 605-361-7785 or 1-800-952-5539.