"*" indicates required fields Step 1. Contact InformationName* First Last Organization Email* Enter Email Confirm Email Phone*Cell PhoneAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Step 2. MealsGrand Reception, Tuesday, February 70123456Breakfast, Wednesday, February 80123456Annual Meeting Lunch, Wednesday, February 80123456Breakfast, Thursday, February 90123456Awards Luncheon, Thursday, February 90123456Reception and Final Event, Thursday, February 90123456First Time Attendee?SelectYesNoAdditional Requests, Comments or Special Dietery NeedsStep 3. Conference RegistrationNumber of guests/family members - Cost for entire conference $225.00 per person QuantityFamily Members & Guests must register to attend the events and pay a fee to attend. Family or guests must be 21 years of age to attend the reception or off-site event. The fee for the person allows them to attend all meals/receptions and the Reception/Off site event on Thursday. Price: $225.00 Quantity Name of the person(s)$350 Full conference registration(s) for TPSA members until 1/20/2023 (after: $450.00 for TPSA members) Quantity Price: $450.00 Quantity Third attendee FREE for government and not-for-profits reduction (select at least three attendees below) Quantity Price: $0.00 Quantity List name(s) here for conference badge(s)$375 Full conference registration for non-members until 1/20/2023 (after $475 for non-members) Quantity Price: $475.00 Quantity $225 One day registration - Wednesday, Feb. 8 Quantity Price: $225.00 Quantity List name(s) here for conference badge(s)$225 One day registration - Thursday, Feb. 9 Quantity Price: $225.00 Quantity List name(s) here for conference badge(s)TOTAL Enter payment at the end of this form.Step 4. Membership(IF YOU HAVE NOT RENEWED YOUR MEMBERSHIP) - The Pesticide Stewardship Alliance - 2023 Membership Form - September 1, 2022 - August 31, 2023 (not a part of Conference Registration)Individual – $75 (Membership is free to Sponsors contributing $1,500-$5,499.) Quantity Price: $75.00 Quantity Provide full name, address, phone number and email below.Organization – $200 (Membership is free to 3 members per organization in an organizational membership. Also, free to Gold Sponsors contributing $5,500 or more) Quantity Price: $200.00 Quantity Provide full name, address, phone number and email below.TOTAL Step 5. Affiliation of MembershipEach member please select one of the following areas of affiliation that represents your primary personal/professional area of focus within TPSA.Choosing one affiliation per member does NOT prohibit any TPSA member from being actively involved in any TPSA committee, group, meeting, or voting. Affiliation records serve to assist with Conference planning, Membership assessment, BOD nominations, and overall Organization focus.Choosing one affiliation per member does NOT prohibit any TPSA member from being actively involved in any TPSA committee, group, meeting, or voting. Affiliation records serve to assist with Conference planning, Membership assessment, BOD nominations, and overall Organization focus. UNITED STATES ENVIRONMENTAL PROTECTION AGENCY (U.S. EPA) Individuals employed by the U.S. EPA. GOVERNMENT AGENCY Individuals employed by a local, state or federal agency (except the U.S. EPA). PESTICIDE INDUSTRY Entities or organizations that manufacture, formulate or distribute pesticides; manufacture or distribute pesticide containers; conduct pesticide research, education, training or consultation; manufacture, sell or distribute equipment and/or other products that are utilized in any aspect of pesticide manufacture, commerce, packaging, transport, application, use, and storage; and pesticide industry sponsored and funded organizations that undertake pesticide stewardship activities. WASTE MANAGEMENT INDUSTRY Entities or organizations that identify, package, or transport waste pesticides and residues, recycle waste pesticides and residues and/or pesticide equipment or containers or manufacture equipment to accomplish any of the above; and any waste-management industry sponsored and funded organizations that undertake pesticide stewardship activities. PESTICIDE CONTAINER MANAGEMENT INDUSTRY Organizations that are involved in any aspect of pesticide container management and any pesticide container management industry sponsored and funded organizations that are involved with pesticide stewardship activities. INSTITUTIONS Entities that are involved with research, teaching or extension in an area or areas of pesticide stewardship. END USERS Individuals or businesses that use or apply pesticides and organizations, trade associations or commodity groups that represent end-users or applicators. PUBLIC OR ENVIRONMENTAL HEALTH Individuals and organizations that are involved with environmental and natural resource protection, recycling, pollution prevention or other conservation or ecological issues and any other corporations that do not fit into any other category. NON-AFFILIATED Individuals and organizations that do not wish to identify with or do not fit into an area of affiliation listed above. Step 6. Sponsor Information - For those who wish to support TPSASponsor Gold Sponsor $5,500+ Free annual organizational membership, for one year, for three members of the sponsoring organization. Free booth space at the Annual Stewardship Conference. Recognized on the TPSA home page and all Conference Sponsor materials. Special recognition at the Annual Stewardship Conference and Annual members meeting. Amount Select Amount$5,500$6,500$7,500$8,500$9,500$10,500Company name here Silver Sponsor $1,500 - $5,499 Free annual membership, for one year, for one member of the sponsoring organization. Free booth space at the Annual Stewardship Conference. Recognized on the TPSA home page and all Conference Sponsor materials. Special recognition at the Annual Stewardship Conference and Annual members meeting. Amount Select Amount$1,500$2,000$2,500$3,000$3,500$4,000$4,500$5,000$5,499Company name here... Bronze Sponsor $750 - $1,499 Individual Sponsors are recognized during the Annual conference. Free booth space, if requested and available, at the Annual Stewardship Conference Amount Select Amount$750$850$950$1,050$1,150$1,250$1,350$1,499Company name here... Additional Sponsorship Opportunities Provide financial sponsorship for specific conference events. Interested Sponsors call (314) 849-9137 for details. Free Table top display 10' Display Step 7. PaymentPayment - pay with credit card or if paying by check, make payment to TPSA with a copy of the registration form and mail to TPSA, 11327 Gravois Road, Suite 201, St. Louis, MO 63126. To pay with credit cards, click below. You do not need to have a PayPal account to use this function. If paying by PayPal and paying for someone besides yourself – please include their name(s) to ensure payment is applied to proper person. * Payable in US dollars. * By paying for conference, attendee gives permission to be contacted by TPSA via email.Hotel Reservations Whitney Peak Hotel 255 N. Virginia St. Reno, NV 89501 (775) 398-5400 Reservations: Reservations can be made by calling (775) 398-5400 or booking online using the links below. If calling to make room reservations please mention you’re with The Pesticide Stewardship Alliance Annual Conference to get the special rate. RATES: Government Rate Link: $114 (plus taxes & fees) TPSA-Reservation Link - Gov. Standard Rate: $145 (single/double occupancy, plus taxes & fees) web-link: TPSA-Reservation Link Note the following: Group rates valid 3 days pre/post (subject to availability). Last day to book: January 11, 2023 Check-in time is 3:00 pm and check-out time is 11:00 am. Reno-Tahoe International Airport – 6 miles to hotel – Approx. 15 minutes. Parking – complimentary self-parking, valet $10/day. Any cancellation/refund request must be made in writing to the TPSA office and submitted by January 23rd, 15 days prior to the scheduled Conference starting date. An administrative fee of $50.00 will be charged to process the refund. If payment is made through PayPal, the refund will be returned via PayPal. PayPal fees may apply and will be charged to the person requesting the refund. No refunds after January 21, 2023, except for medical emergencies or death in the family. Consideration will be on an individual basis and in consultation with the TPSA President.GRAND TOTAL *** Pay for your registration securely by clicking the PayPal button below. You can use the PayPal Guest Checkout to pay with any major credit card. A PayPal account is not required. ***
