House of Delegates Registration House of Delegates Registration Form Please fill out the form below to register for the 2025 House of Delegates. "*" indicates required fields Step 1 of 2 50% Contact DetailsName* First Last Email* Cell Phone*Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Attending As*Click to SelectPASNAP MemberRetired PASNAP MemberPASNAP Executive Board MemberPASNAP StaffGuestLocal Association*Click to SelectArmstrong NursesArmstrong TechsBrooke GlenButlerChestnut Hill RNsChestnut Hill TechsCrozer NursesCrozer ParamedicsCrozer PharmacistsCrozer ProsEaglevilleEinsteinFair AcresFox Chase RNsFox Chase TechsFox Chase OCR Pro UnitGCMC Allied ProsGCMC/NEPANAGeisinger Clinic Advanced PractitionersIndiana RNsJeanes RNsJeanes Techs & ProsLower BucksMercy FitzgeraldNATUPottstownSt. Christopher'sSt. MarySuburbanTDEUTaylor RNsTAPTFPPTUHNAT-NACWarrenWills EyeWV CRNAAWVNAPASNAP StaffRetired PASNAP MemberN/A GuestFounding Members I was a Founding Member of PASNAP If you were a member of PASNAP when it was founded in 2000, please check the box above. Room SelectionPlease choose one room selection below. We strongly encourage members/retirees to share rooms this year, as we are very limited on space. Also, please note that anyone requesting a private room is not guaranteed a room with one king bed - you are only guaranteed a room by yourself. Most of the rooms in this hotel are 2-queen rooms - 1-king rooms are not guaranteed.Roommate Name (if applicable)Double Room – Member/Retired Member Sunday, April 27, 2025 Monday, April 28, 2025 Both Sunday & Monday Nights If you are a PASNAP member, and you share a room with another member, there will be no cost to you. If you plan to share a double room but haven’t named a roommate, one will be assigned to you. Incidentals are the responsibility of the attendee, and a valid credit card will be required at check-in.At the moment, we are at capacity for private rooms at this facility, but we may have additional capacity at a later date. If you're interested in a private room, please select from the following options. You will not incur a charge at this time.Private Room – Member/Retired Member Sunday, April 27, 2025 – $82.69 Monday, April 28, 2025 – $82.69 Both Sunday & Monday Nights – $165.39 If you are a member and you would like a private room, you are required to pay half the cost of the room per night, $82.69 ($165.39 for both nights). *Rooms with one king bed are not guaranteed. Incidentals are the responsibility of the attendee, and a valid credit card will be required at check-in.This field is hidden when viewing the formI am willing to stay in off-site lodging Yes No Private Room – PASNAP Exec. Board Member / PASNAP Staff Member / Speaker / PASNAP Invited Guest Sunday, April 27, 2025 Monday, April 28, 2025 Both Sunday & Monday Nights Speaking guests, PASNAP Board Members, and PASNAP Staff are entitled to a private room free of charge (room & tax only). Incidentals are the responsibility of the attendee, and a valid credit card will be required at check-in.Double Room – PASNAP Member/Retiree with Guest Sunday, April 27, 2025 – ($82.69 + $50 for guest meals) - $132.69 Monday, April 28, 2025 – ($82.69 + $50 for guest meals) - $132.69 Both Sunday & Monday Nights – ($165.39 + $50 for guest meals) - $215.39 A PASNAP member who is bringing a guest (such as a spouse) will be responsible for half the cost of the room per night, plus $50 for guest meals. Incidentals are the responsibility of the attendee, and a valid credit card will be required at check-in.No Room (HOD Registration Only) Sunday, April 27, 2025 Monday, April 28, 2025 Tuesday, April 29, 2025 Select AllIf you are not planning on staying overnight at the hotel, but will be attending House of Delegates during the day, please choose which days you'll be attending.Payment DetailsPayment is only required if you selected a paid room type. If the total amount listed below is $0.00 or does not appear, you can skip ahead and click REGISTER below. If you selected a paid room type, changed your selection, and the total still appears, please reload the registration form to zero out any accidental selections.Total: Credit CardCard Details Cardholder Name Please click the REGISTER button only once. Processing may take a few moments. Clicking multiple times may result in duplicate charges. Δ