NCSTAE Registration - Pennsylvania Telephone Association

November 5-7, 2025
The Mills House – Charleston, SC

"*" indicates required fields

Association/Company Information

Company Name*

Contact Person*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Registration Fees

Association/Company Representative: $700.00

Guest: $150.00 (includes scheduled meals only)

Number of Registrants

How many people would you like to register?*

Registrant #1

Name*

First Last

Registration Type*

I have a special dietary need.

Yes, please contact me.

If you have special dietary needs, we will contact you for further details.

Registrant #2

Name*

First Last

Registration Type*

I have a special dietary need.

Yes, please contact me.

If you have special dietary needs, we will contact you for further details.

Registrant #3

Name*

First Last

Registration Type*

I have a special dietary need.

Yes, please contact me.

If you have special dietary needs, we will contact you for further details.

Registrant #4

Name*

First Last

Registration Type*

I have a special dietary need.

Yes, please contact me.

If you have special dietary needs, we will contact you for further details.

Registrant #5

Name*

First Last

Registration Type*

I have a special dietary need.

Yes, please contact me.

If you have special dietary needs, we will contact you for further details.

Payment Information

Method of Payment

Please choose your method of payment below. All payments are due no later than 10/17/2025. No refunds after 10/17/2025.

Payment Method*

Check (send by 10/17/2025)

Credit Card (those paying by credit card will receive an invoice from PTA along with a secure link for payment)

Checks should be made payable to:
Pennsylvania Telephone Association
Mail to: 30 N. Third Street, Suite 780, Harrisburg, PA 17101

Questions call 717-238-8311

Total Registration Fee

Total

Name

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