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O C T O B E R 2 0 - 2 3 , 2 0 1 3 F O R T W O R T H C O N V E N T I O N C E N T E R

ABOUT YOU

Last Name First Name MI

First Name for Badge Professional Certification PHR SPHR GPHR

Company Title

Address

City/State/ZIP

Email Phone Fax

Emergency Contact Name Emergency Contact Phone Number

SHRM Member # OR DallasHR Member # OR SHRM Texas Chapter Name Membership number must be provided to receive any applicable discounts. Please send me more info on joining my local Texas chapter.

I do OR I do not - wish to receive email communications from Conference sponsors and exhibitors including event invitations, Conference-related contests, and special announcements. I understand I will be able to unsubscribe from email lists at any time.

I authorize OR I do not authorize HRSWC to include only my name, title, company, and city/state on the sample attendee list. YES, I would like to receive Conference updates by text message. I can opt out any time and text message rates may apply. Cellphone #

What most influenced your decision to attend HRSWC? Previous attendee Friend or colleague recommendation HRSWC brochure or postcard HRSWC email Industry magazine ad/article Phone call from HRSWC Communication from my Texas SHRM chapter Social network promotion (Facebook, LinkedIn, Twitter, etc.) Internet search Other

How many years have you attended The HRSouthwest Conference? First-time 1-3 4-6 7-9 10+

What is your role in purchasing HR products or services for your company? Final decision Review and recommend Not involved

Number of years in the HR industry

1-5 5-10 10-15 15-20 20-30 30+

Age range 18 to 34 35 to 44 45 to 54 55 to 64 65+

Gender Male Female

Race/Ethnicity American Indian/Alaskan Native Asian/Pacific Islander

African American Hispanic Caucasian Multicultural

Other:

What is your company’s industry? Agriculture, Forestry, Fishing Arts, Entertainment, Recreation Association - Professional/Trade Awards Programs Biotech Construction & Mining Educational Services Finance Govt./Public Admin - Federal Govt./Public Admin - State/Local Health Care High-Tech Hospitality Independent Consultant Insurance Legal Library-Any Manufacturing Management Companies, Enterprises Newspaper Publishing and Broadcasting Outsourcing Pharmaceutical

Real Estate Services - Professional, Scientific, Technical Services (Non-Profit) Services (Profit) Telecommunications Transportation Utilities, Energy Waste Management, Remediation Svcs Wholesale/Retail Trade Other:

Please select the position that most closely matches yours

President/CEO Senior Vice President/Vice President Director Assistant Director Manager Coordinator Administrator Other

Your role at your company - please choose all job functions that you perform:

Administrative Benefits Communications Compensation Consulting Diversity/Inclusion EEO/Affirmative Action Employee Relations Employment/Recruitment Health/Safety/Security HR Generalist HRIS International HRM Labor Relations Legal Organizational Development Personnel Research Training & Development Other:

How important are these factors in your decision to attend HRSWC? Cost of registration Very important Somewhat important Neutral Somewhat unimportant Very unimportant Travel expenses Very important Somewhat important Neutral Somewhat unimportant Very unimportant Schedule (dates of Conference) Very important Somewhat important Neutral Somewhat unimportant Very unimportant Networking opportunities Very important Somewhat important Neutral Somewhat unimportant Very unimportant Meeting with exhibitors/suppliers Very important Somewhat important Neutral Somewhat unimportant Very unimportant Educational content Very important Somewhat important Neutral Somewhat unimportant Very unimportant # of HRCI recertification hours Very important Somewhat important Neutral Somewhat unimportant Very unimportant Conference location Very important Somewhat important Neutral Somewhat unimportant Very unimportant

How will you travel to The HRSouthwest Conference? By air By car I am local and will commute

Find special air, car rental and hotel discounts at hrsouthwest.com/housing

Would you like to volunteer as a Session Coordinator? Yes No

Session coordinators introduce speakers, distribute and collect evaluations, usher attendees, and work with the Educational Sessions Committee.

ONLINE: www.hrsouthwest.com/register

FAX: (214) 631-4533 (allow 7-10 business days for processing)

MAIL: The HRSouthwest Conference 4100 Spring Valley Rd Ste 300 Dallas, TX 75244 (allow 7-10 business days for processing)

EMAIL: attendees@hrsouthwest.com

This form can completed using free Adobe Reader software. PLEASE TYPE OR PRINT CLEARLY. Use one form per registrant.

www.hrsouthwest.com Page 2 of 2

In case these pages are separated, please include your FULL NAME HERE

CUSTOMIZE YOUR CONFERENCE EXPERIENCE

$89 ONLINE LEARNING CENTER ACCESS –Earn additional HRCI recertification credits and extend your Conference experience. Select sessions from the 2013 Conference (approx. 30+ video and 30+ audio) will be recorded and available on-demand via the HRSWC Online Learning Center for six months. This special pre-registration rate is only available to 2013 Conference attendees who register before October 18, 2013. Technical requirements: Current browsers support HTML5. Older versions require QuickTime plugin or latest Flash Player (11.5).

FULL CONFERENCE REGISTRATION – Includes Conference materials, access to General Sessions, Educational Sessions, Exhibit Hall, lunch on Monday and Tuesday, refreshment breaks, Welcome and Closing Receptions. By June 1 By Aug 31 By Oct 18 Onsite (Oct 19-23) DallasHR Member $600 $660 $760 $860 SHRM Texas Chapter Member $735 $795 $895 $995 SHRM Member $795 $855 $955 $1055 Non-Member $895 $955 $1055 $1155 ONE-DAY REGISTRATION - Includes access to General Sessions, Educational Sessions, Exhibit Hall, and any Conference event taking place on that day. Wednesday, October 23 is a half day. Mon Oct 21 Tue Oct 22 Wed Oct 23 Onsite (Oct 19-23) DallasHR Member $350 $350 $150 $375 $375 $175 SHRM Texas Chapter Member $400 $400 $175 $425 $425 $200 SHRM Member $450 $450 $200 $475 $475 $225 Non-Member $500 $500 $225 $525 $525 $250 PRE-CONFERENCE WORKSHOPS – Full or One-Day Conference registration required to receive attendee rate. Onsite workshop transfers are not available. Attendee Non-Attendee Onsite (Oct 19-20) PHR/SPHR Crash Course – Full Day Sun Oct. 20 $275 $375 $425 Understanding Metrics: The Practical Approach for Improving Business Performance Jim Vance, SPHR Half-Day Sat. Oct 19+Full Day Sun Oct. 20. Strategic credit pending HRCI approval

$500 $650 $700

Transform your Culture from "Leave It to Love It! - Alice Dendinger, SPHR Half-Day Sun Oct. 20. Strategic credit pending HRCI approval

$150 $225 $260

Engaging and Retaining Employees: The Impact on the Bottom Line Value Colleen Affeldt - Half-Day Sun Oct. 20. General credit pending HRCI approval

$150 $225 $260

Business and HR Strategy Integration - Kevin Rutherford, SPHR Half-Day Sun Oct. 20. Strategic credit pending HRCI approval

$150 $225 $260

$200 - Yes, I wish to SPONSOR A STUDENT. Each year, more than 100 students are able to participate in full The HRSouthwest Conference thanks to generous sponsors. Sponsoring a student for The Conference is a great way for you or your organization to promote education and to encourage current college students to pursue a career in the HR field. Sponsors are acknowledged with a flyer included in every conference attendee bag.

$100 MARKETPLACE ONLY (per day) – includes access to Markeplace for one day, lunch and refreshment breaks. Select Monday OR Tuesday

GUEST PASS $50 Reception Sun 10/20 $50 Reception Tue 10/22 Guest Name Guests may not be in an HR industry-related position. Co-workers or associates in the industry do not qualify. Guests must be at least 18 years of age.

SPECIAL ACCOMMODATIONS: If you require special accessibility or dietary accommodations please contact Conference Management at (214) 631-7476 or email attendees@hrsouthwest.com.

PAYMENT INFORMATION Payment must be for the correct full amount; no partial payments accepted. A faxed form must include credit card information. Purchase orders will be accepted from Government Agencies only. I authorize HRSWC to charge my: AMEX VISA MasterCard Check payable to The HRSouthwest Conference (Tax ID # 75-2499356) Credit Card #

Exp. Date

Name on Card

Authorized Signature

Promo Code Discounts or promotional rates will be applied to final payment

Total Due $ Total amount due will be verified before payment is processed.

I have read and agree to the terms and conditions outlined below

TERMS AND CONDITIONS 1. Email confirmation will be provided after receipt of registration and payment in accordance with payment terms. Pre-registration (printed or online) will not be accepted after

October 18, 2013. Onsite registration will be available October 19-23, 2013. 2. By registering for The HRSouthwest Conference, I understand that HRSWC reserves the right to use any photograph/video taken at any event sponsored by HRSWC, without the

express written permission of those included within the photograph/video. The HRSWC may use the photograph/video in publications or other media material produced, used or contracted by the HRSWC including but not limited to: brochures, invitations, books, newspapers, magazines, television, websites, etc.

3. By registering for The HRSouthwest Conference, I understand that my information may be shared with official Conference partners such as the housing bureau, Online Learning Center partner, or others, in order to facilitate access to exclusive Conference materials and information. To select preferences regarding communications from sponsors and exhibitors, please see the opt in/opt out section at the top of Page 1.

4. Cancellation Policy All Cancellations & Transfers must be submitted in writing to The HRSouthwest Conference and incur an administrative fee. Cancellation Refund Policy:

− All cancellations will be assessed a $75 administrative fee. − Received on or before August 15, 2013, 100% refund (less administrative fee). − Received on or before September 13, 2013, refund of 50% (less administrative fee). − After September 13, 2013, no refund is available.

5. Transfer Policy: Registrations may be transferred to another individual and must be in writing. Prevailing registration fees will apply and incur a $50 administrative fee. If registration is paid by employer, the employer owns the registration and reserves the right to transfer or cancel. Registrations are not transferrable to future events.

6. Expo Only and guest passes are non-refundable. 7. The HRSouthwest Conference reserves the right to cancel or revoke any registration for any reason without refund.