Entering the ARC-PA Provisional Accreditation Pathway REGISTRATION
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Entering the ARC-PA Provisional Accreditation Pathway
November 20-21, 2014
Deadline for Receipt of Registration Form October 14, 2014; Payment due November 1, 2014
Institution Name: Click here to enter text.
Date of Planned Program beginning: Click here to enter date (Mo/Year).
Date of Site Visit, if scheduled: Click here to enter date (Mo/Year).
Is institution regionally accredited to offer graduate degree?
Yes☐ No ☐
If so, enter regional accreditor: Click here to enter text.
registrant #1
First Name, Last Name, Credentials: Click here to enter text.
Role in Institution: ☐Dean ☐Associate Dean ☐PA Program Director ☐other: Click here to enter text.
Mailing address: Click here to enter Street, City, State and Zip
Daytime phone number with area code: Click here to enter text.
Email: Click here to enter text. Physical/dietary needs: Click here to enter text.
(Confirmation of registration and correspondence about the conference will be sent to this email address)
registrant #2
First Name, Last Name, Credentials: Click here to enter text.
Role in Institution: ☐Dean ☐Associate Dean ☐PA Program Director ☐other: Click here to enter text.
Mailing address: Click here to enter Street, City, State and Zip
Daytime phone number with area code: Click here to enter text.
Email: Click here to enter text. Physical/dietary needs: Click here to enter text.
(Confirmation of registration and correspondence about the conference will be sent to this email address)
Comments: Click here to enter text.
Registration Fee ($1500 for one, $2500 for two) includes dinner on Thursday, November 20; breakfast, breaks and lunch on Friday, November 21, 2014.
☐Personal Check being mailed separately
☐Institution check to follow
NOTE: The ARC-PA does NOT accept credit cards.
After completing and saving this form, please send it as an email attachment to: . Send the registration fee to Provisional Conference Registration, ARC-PA, 12000 Findley Road, Suite 150, Johns Creek, GA; 30097.
Questions about registration: Contact Mercedes Beard at or 770-476-1224 (EST)
Space is limited and preference will be given to those early registrant eligible individuals beginning programs from 2017 and beyond who have not previously attended.
Submission of this registration form does NOT guarantee registration. Confirmation will be sent via email to the email addresses for each registrant.
Please note that there is a limited block of hotel rooms at the Renaissance Airport Atlanta Airport Hotel on hold for this conference. In order to secure a room at the conference hotel, hotel reservations must be made by October 25, 2014.
Air, hotel and other travel arrangements should NOT be made until you receive confirmation of conference registration.