A Day of Authors 2022

First Name*

Last Name*

Email*

Phone*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Preferences for Break-Out Sessions

Please indicate your choices for BOTH SESSIONS by numbering the list below from 1-5 with 1 as your FIRST CHOICE. Note: If your choices are filled and you have not specified alternate options, we will place you where an opening occurs.

Breakout Session Preferences*

Breakout Session Preferences
	_____1_____	_____2_____	_____3_____	_____4_____	_____5_____
Lian Dolan	Breakout Session Preferences: Lian Dolan (_____1_____)	Lian Dolan (_____2_____)	Lian Dolan (_____3_____)	Lian Dolan (_____4_____)	Lian Dolan (_____5_____)
Shilpi Somaya Gowda	Shilpi Somaya Gowda (_____1_____)	Shilpi Somaya Gowda (_____2_____)	Shilpi Somaya Gowda (_____3_____)	Shilpi Somaya Gowda (_____4_____)	Shilpi Somaya Gowda (_____5_____)
Sarah James	Sarah James (_____1_____)	Sarah James (_____2_____)	Sarah James (_____3_____)	Sarah James (_____4_____)	Sarah James (_____5_____)
Autumn Krause	Autumn Krause (_____1_____)	Autumn Krause (_____2_____)	Autumn Krause (_____3_____)	Autumn Krause (_____4_____)	Autumn Krause (_____5_____)
Andrea Lankford	Andrea Lankford (_____1_____)	Andrea Lankford (_____2_____)	Andrea Lankford (_____3_____)	Andrea Lankford (_____4_____)	Andrea Lankford (_____5_____)

I would like to be seated with:

I heard about this event through:

Name of ALPHA Member (if applicable)

Do you want to purchase NEW Opportunity Tickets for two chances to win $500?*

Yes No

How many Opportunity Tickets would you like?

Reservation Fee* $

Includes coffee, pastry, lunch, and parking.

Additional Contribution $

For ALPHA philanthropic projects. (We welcome contributions and list donors in our program.)

2.99% + $0.49 Processing Fees $

TOTAL $