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Company
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Contact
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Contact
email:
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Address:
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Zip:
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City:
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State:
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Check here if first time attendee
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Title:
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1.
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Name
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email:
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Phone:
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Check here if first time attendee
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2.
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Name:
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Title:
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email:
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Phone:
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Check here if first time attendee
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3.
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Name:
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Title:
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email:
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Phone:
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Check here if first time attendee
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4.
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Name:
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Title:
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email:
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Phone:
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If new attendee, provide name of person who referred you to our conference
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Total # registering
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Total Amount Due:
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Check here if you will be mailing a check
Mail U.S. funds check issued to Utility Payment Conference to address listed on left
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Check here if you are paying with your Discover, MasterCard or Visa card
Card payment link is on our Home Page.
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Total Amount Due:
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Grand Total Due:
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Registration Information
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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.
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Liability Release Waiver Information
My/Our registration indicates I/We agree to release the Utility Payment Conference and
hotel and each of their respective officers, directors, agents, representatives, and
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.
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Cancellation and Change Policy
My/Our submitted registration form indicates I/We have read, understand and agree to
the conference Cancellation and Change Policy.
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Hotel Reservation Release
I/We hereby give the Utility Payment Conference and its delegated representatives
permission to inquire of the hotel information regarding my booked reservation. In
addition, the conference hotel(s) has my/our permission to disclose my/our
reservation information to the conference's delegated representation.
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