2018 Summit Individual Registration

Name*

First Last

Company/Organization*

Title/Position

Are you registering under a company's 2018 Diversity Summit Sponsorship?*

Yes
No

If yes, which company?

Address*

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

Phone*

Email*

Breakout Session One (10:15 a.m. - 11:30 a.m.)*

Breakout Session Two (1:00 p.m. -2:15 p.m.)*

Breakout Session Three (2:30 p.m. -3:45 p.m.)*

Please indicate any accommodations you require for this event:

Wheelchair Access
Sign Language Interpreter
Language Translator
Bringing Support Dog
Other (include in Questions/Comments section)

Additional Registrants

This is for additional guests that you will be registering alongside yourself.

Are you registering anyone else for the Diversity Summit?*

First Additional Registrant

This is an additional guest that you will be registering alongside yourself. You will be purchasing two tickets in total.

Name*

First Last

Title/Position

Phone*

Email*

Breakout Session One (10:15 a.m. - 11:30 a.m.)*

Breakout Session Two (1:00 p.m. -2:15 p.m.)*

Breakout Session Three (2:30 p.m. -3:45 p.m.)*

Please indicate any accommodations this registrant requires for this event:

Wheelchair Access
Sign Language Interpreter
Language Translator
Bringing Support Dog
Other (include in Questions/Comments section)

Second Additional Registrant

This is a second additional guest that you will be registering alongside yourself. You will be purchasing three tickets in total.

Name*

First Last

Title/Position

Phone*

Email*

Breakout Session One (10:15 a.m. - 11:30 a.m.)*

Breakout Session Two (1:00 p.m. -2:15 p.m.)*

Breakout Session Three (2:30 p.m. -3:45 p.m.)*

Please indicate any accommodations this registrant requires for this event:

Wheelchair Access
Sign Language Interpreter
Language Translator
Bringing Support Dog
Other (include in Questions/Comments section)

Third Additional Registrant

This is the third additional guest that you will be registering alongside yourself. You will be purchasing four tickets in total.

Name*

First Last

Title/Position

Phone*

Email*

Breakout Session One (10:15 a.m. - 11:30 a.m.)*

Breakout Session Two (1:00 p.m. -2:15 p.m.)*

Breakout Session Three (2:30 p.m. -3:45 p.m.)*

Please indicate any accommodations this registrant requires for this event:

Wheelchair Access
Sign Language Interpreter
Language Translator
Bringing Support Dog
Other (include in Questions/Comments section)

Fourth Additional Registrant

This is the fourth additional guest that you will be registering alongside yourself. You will be purchasing five tickets in total.

Name*

First Last

Title/Position

Phone*

Email*

Breakout Session One (10:15 a.m. - 11:30 a.m.)*

Breakout Session Two (1:00 p.m. -2:15 p.m.)*

Breakout Session Three (2:30 p.m. -3:45 p.m.)*

Please indicate any accommodations this registrant requires for this event:

Wheelchair Access
Sign Language Interpreter
Language Translator
Bringing Support Dog
Other (include in Questions/Comments section)

Cancellation Policy

Cancellation Policy*

I understand

If you need to cancel your registration, 14 business days’ notice prior to the Summit date is required for a refund of your registration cost. No refunds will be made after this date for any reason. Substitutes may be made at any time, without additional charges.

Tickets

General Ticket

Price: $220.00

Single Student (High School) Ticket

Price: $100.00

Total

$0.00

Payment Method*

Online (Will be redirected to PayPal)

Questions/Comments

Sign-up for DAP Newsletter

Absolutely!
No, thank you.
I'm already signed up.

Name

This field is for validation purposes and should be left unchanged.

2018 Diversity Summit Registration

Additional Registrants

First Additional Registrant

Second Additional Registrant

Third Additional Registrant

Fourth Additional Registrant

Cancellation Policy

Tickets