Conference Registration Form

Name:

Title

First

Last

Position:

Email:

Business Phone:

Cell Phone:

Company:

Address:

City:

State:

Zip Code:

Country:

Topic Selection:

	Topic Title	Date & Time	Fee
1	Topic A	12/4/2021, 10:00 AM	$200.00
2	Topic B	12/4/2021, 1:00 PM	$200.00
3	Topic C	12/4/2021, 3:00 PM	$200.00
4	Topic D	12/5/2021, 10:00 AM	$200.00
5	Topic E	12/5/2021, 1:00 PM	$200.00
6
7	Each topic costs $200. You get discount of $10 x number of topics when you select more than 1 topic. E.g. if you select 5 topics, each topic costs $200 - $10x5 = $150	Total $	$0.00

Join our conference networking dinner after the conference, starting at 6pm. It’s an opportunity to kick back and mingle with other conference attendees. You can also bring along your colleagues or friends to attend this great event.

The cost of the dinner is $120 per person.

Yes, I’d like to join the conference networking dinner.

Number of additional diner (leave empty if it’s just you):

Total Conference Fee: