Payments – SC HOSA Future Health Professionals

This form ONLY pays your registration and/or admin fees.
It does NOT register you for the conference.
There are processing fees associated with credit/debit card payments.
- Registration fees $3 (per registration) for a total of $93 per registration
- Admin fee (for changes) $1 for a total of $26 per occurrence. NO charge for deletions.
- HOSA University fees $1 & $2 for a total of $26 & $52, depending on the session you attend.

Advisor's Name*
School*
Billing Name*
Email Address*
Billing Address*
Street Address City State ZIP Code
Conference Registration Fees
Students
Student Registration Fee
Price: $93.00 Quantity:
Advisors
Advisor Registration Fee
Price: $93.00 Quantity:
Chaperone/Guest
Chaperone/Guest Registration Fee
Price: $93.00 Quantity:
HOSA University Fees
HOSA 100
There is a $1 processing fee add to the fee when using a credit/debit card)
Price: $26.00 Quantity:
HOSA 101 Local Members
There is a $1 processing fee add to the fee when using a credit/debit card)
Price: $26.00 Quantity:
HOSA 102 Advanced HOSA Members
There is a $1 processing fee add to the fee when using a credit/debit card)
Price: $26.00 Quantity:
HOSA 201 Chapter Officers
There is a $1 processing fee add to the fee when using a credit/debit card)
Price: $26.00 Quantity:
HOSA 301 State Officers
There is a $1 processing fee add to the fee when using a credit/debit card)
Price: $26.00 Quantity:
HOSA 401 NEW Chapter Advisor
There is a $2 processing fee add to the fee when using a credit/debit card)
Price: $52.00 Quantity:
HOSA 501 ADVANCED Chapter Advisor
There is a $2 processing fee add to the fee when using a credit/debit card)
Price: $52.00 Quantity:
Substitution Fee
Administration (change) FEE
$25 fee, If you are making changes after the published deadlines. There is a $1 processing fee add to the fee when using a credit/debit card)
Price: $26.00 Quantity:
Your Total
$0.00
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2019 Fall Leadership Conference Registration Fee PAYMENT