First Name *

Last Name *

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What is your MIPERC Conference Affiliation? *
- Select Option Member - MIPERC (Institution) ($25.00) Non-Member - MIPERC (Institution) ($50.00) Presenter - MIPERC Conference Facilitator - MIPERC Conference Student

Membership Institution
- Select Option Ball State University Battle Creek Public Schools Bowie State University Creighton University Eastern Michigan University Michigan State University-CHM Mary Free Bed Oakland University Saginaw Valley State University Grand Valley State University Ferris State University Grand Rapids Community College Corewell Health (Spectrum Health) University of Michigan University of South Dakota University of Wisconsin-Madison Winona State University