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DATIA 2020 Annual Conference Registration Form

* Required
Company* Registrant Name*
Address* City* State* Zip*
Phone* Fax Email*
Please indicate which industry segment you represent with the following options:

Employer
Product Manufacturer/Provider
Collection Facility
Consortium/TPA
Medical Review Officer (MRO)
Substance Abuse Professional (SAP)
Employee Assistance Programs (EAP)
Other

If Other, please specify
Please indicate any special dietary needs (food allergies, vegan, vegetarian, etc.)
Early Rate
(Before March 13, 2020)
Normal Rate Registrant Name Registrant Email
Members $449 $549
Members - 2nd person $399 $499
Members - 3rd person $349 $449
Members - 4th person $299 $399
Members - 5th person $249 $349
Non-Members $699 $799
Non-Members - 2nd person $649 $749
Non-Members - 3rd person $599 $699
Non-Members - 4th person $549 $649
Non-Members - 5th person $499 $599
*Please note that if you register more than 5 people, additional people will be registered at the 5th person rate.
SAVE BIG! Sign up as a DATIA member now and save $250 on each conference registration and $150 on each training course registration. Memberships are organization memberships so you will save for each company representative and YOU WILL SAVE MORE THAN THE DUES AMOUNT. Your membership will be valid through September 2020.
(Visit datia.org for complete membership benefit breakdowns)
$148 Regular Member (1-5 employees) $298 Corporate Member (6+ employees) $1,150 Sustaining Member
DATIA Opening Reception
(Included in registration fee for registrants. NOTE: Guests accompanying attendees must register to attend.)
$30 x # Guest name(s):
Thursday Evening Networking Event
(Included in registration fee for registrants. NOTE: Guests accompanying attendees must register to attend.)
$50 x # Guest name(s):
Training Courses
Advanced Collection Issues and Best Practices
Participant_1: Saturday, May 30, 2020
       8AM - 12PM
$299 Member
$449 Non-member
Participant Name
Advanced DER Training
Participant_1: Saturday, May 30, 2020
       8AM - 12PM
$299 Member
$449 Non-member
Participant Name
Certified Professional Collector Trainer® Training
Participant_1: Wednesday, May 27, 2020
       8AM - 5PM
Saturday, May 30, 2020
       8AM - 5PM
$399 Member
$549 Non-member
Participant Name
Collector Refresher and Mock Collection Course
Participant_1: Wednesday, May 27, 2020
       1PM - 5PM
$299 Member
$449 Non-member
Participant Name
Consortia/Third Party Administrator Best Practices
Participant_1: Wednesday, May 27, 2020
       8AM - 5PM
Saturday, May 30, 2020
       8AM - 5PM
$399 Member
$549 Non-member
Participant Name
DER Compliance: A Train-the-Trainer Workshop
Participant_1: Wednesday, May 27, 2020
       8AM - 5PM
Saturday, May 30, 2020
       8AM - 5PM
$399 Member
$549 Non-member
Participant Name
Developing an Effective Supervisor Training Program
Participant_1: Wednesday, May 27, 2020
       1PM - 5PM
$299 Member
$449 Non-member
Participant Name
Excelling as an MRO Assistant Workshop
Participant_1: Wednesday, May 27, 2020
       8AM - 5PM
$399 Member
$549 Non-member
Participant Name
Ins and Outs of Drug and Alcohol Testing
Participant_1: Wednesday, May 27, 2020
       8AM - 12PM
$299 Member
$449 Non-member
Participant Name
Oral Fluid Specimen Collections
Participant_1: Wednesday, May 27, 2020
       8AM - 12PM
Saturday, May 30, 2020
       8AM - 12PM
Saturday, May 30, 2020
       1PM - 5PM
$299 Member
$449 Non-member
Participant Name
 
Payment Information
Total Due: $
Option 1: Pay By Check

To pay by check, please print this form and mail it to:

DATIA 1325 G Street NW
Suite 500 #5001
Washington, DC 20005

The total amount due on this form will be honored.

Registration is not complete until payment is received.

 
Option 2: Pay By Credit Card
 
Credit Card Type: MasterCard
Visa
American Express
Card #:
Expiration Date:


PROMO CODE:

Type the code shown in parentheses (DATIA2020):

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