Register Name*(as it will appear on your badge) First Last Affiliation(as it will appear on your badge)Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* RegistrationRegistration*$110.00 - Regular membership/renewal + registration ($50 membership + $60 registration)$60.00 - Members – Early Bird Special: register by SEPTEMBER 12th$90.00 - Non-Member – Early Bird Special: Register by SEPTEMBER 12th!$70.00 - Members – after September 12th$100.00 - Non-Member – after September 12th$40.00 - Graduate Student (includes 1-year PHA membership)$0.00 - Undergraduate Student$20.00 - LHS Members Registration (also local non-presenters & additional exhibitor registrants)Reminder: All presenters must be PHA members unless otherwise authorized. Email firstname.lastname@example.org with questions or concerns.Meals & EventsOpening Reception, Thursday, October 12, Lackawanna Historical Society Headquarters*followed by a program introducing a WWI exhibit at the University of Scranton’s Weinberg Library. Wine / Cheese reception sponsored by the Lackawanna Historical Society.$0.00 - Wine / Cheese Reception(Not Attending Opening Reception)Luncheon, Friday, October 13, 2016, Radisson Lackawanna Station Hotel*with Keynote Speaker, PHMC Chair Nancy Moses.$20.00 - Luncheon: Carmen’s Banquet Lunch Buffet(Not Attending Oct 13 Luncheon)Train ride from hotel to Steamtown National Historic Site, Friday, October 13*Sponsored by LCCVB. Train ride takes guest to dinner. Guests will be escorted back to hotel after program or can choose to take the walking tour.$0.00 - Train Ride(Not Attending Train Ride)Dinner, Friday, October 13, 2016, Steamtown National Historic Site*with Keynote Speaker, ICOMOS International Scientific Committee on Cultural Landscapes Brenda Barrett.$35.00 - Dinner(Not Attending Oct 13 Dinner)Scranton After Dark Walking Tour, Friday, October 13*Provided after dinner/keynote as a special Friday the 13th late night tour offering tales of the city’s darker side.$0.00 - Walking Tour(Not Attending Walking Tour)Luncheon, Saturday, October 14, 2017, Platform Lounge Radisson Lackawanna Station*with Keynote Speaker Roger D. Simon.$18.00 - Luncheon(Not Attending Oct 14 Luncheon)EXPLORE SCRANTON, Saturday, October 14*Conference attendees will receive free or reduced admission at several local cultural/historic attractions including the Everhart Museum of Natural History Science and Art, the Anthracite Heritage Museum of Pennsylvania and the GAR Civil War Museum and Archives. plus guided tours of local landmarks like St. Luke’s Episcopal Church, the Albright Memorial Library. We encourage everyone to visit the local sites to discover more about the city’s fascinating history. Maps and Schedules will be provided.$0.00 - Explore Scranton(Not Attending Explore Scranton)TotalRegistration & meals $0.00 Payment Method*Credit CardPayPalCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.