Guest Registration Form
Conference Attendee Company Name:
Conference Attendee Name:
Conference Attendee Phone:
Conference Attendee email:
Guest Name:
Check the appropriate box below:
To be announced
Total
Due:
We're sorry.  We  will be unable to provide a refund for your guest
registration effective September 3.
Payment Option
Check here if you will be mailing a check
Mail U.S. funds check  issued to Utility Payment Conference to address listed on left
Check here if you are paying with your Discover, MasterCard or Visa card
Card payment link is on our Home Page.
Photo Release
I/We hereby give the Utility Payment Conference and its delegated representatives the
permission to photograph me alone and/or with other attendees in conjunction with and
for the conference.  I/We understand the pictures may be used for the promotion of the
conference.  Publications of photographs shall include, but is not limited to, the
conference website, future conferences, promotional brochures and flyers and other
forms of media.
Liability Release Waiver Information
My/Our registration indicates I/We agree to release the Utility Payment Conference, and
each of their respective officers, directors, agents, representatives, employees and hotel,
(referred to collectively as "Releasees") from any and all claims, actions, damages and
liabilities, injury or loss that in any way are caused by, arise out of or result from my
participation in the Utility Payment Conference.
Cancellation and Change Policy
Refunds for guest registrations can be provided up to Friday, September 2.  No refunds
will be provided effective September 3.
Thank you for your interest in bringing a guest to our conference.  We have a few items you
need to be aware of prior to registering your guest.  They are as follows:
1.  No guests are allowed at any conference sessions
2.  Guests must be 21 years or older
3.  Your guest may not be a business associate
  •      An eligible guest is a spouse, significant other or relative
Submit this form electronically, then mail your U.S. funded check to the address listed to the left
of this page or pay with Discover, MasterCard or Visa credit card. Payment link is on home page.
Your guest is invited to participate in our evening event and/or Thursday breakfast buffet.  Guests
must be at least 21 years of age to attend.  

He/She will receive a badge that must be worn at each event they attend.  

Join Us!
www.paymentconference.com
Utility    
Communications, Cooperatives,
Municipalities and Utilities