2019 Summit Individual Registration

Name*

First Last

Company/Organization*

Title/Position

Are you registering under a company's 2019 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. If a guest is no longer able to make it, the replacement’s name must be submitted by June 25, 2019.

Tickets

General Ticket

Price: $200.00

Total

$0.00

Payment Method*

Online (Will be redirected to PayPal)

Questions/Comments

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I'm already signed up.

Comments

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2019 Diversity Summit Registration

Additional Registrants

First Additional Registrant

Second Additional Registrant

Third Additional Registrant

Fourth Additional Registrant

Cancellation Policy

Tickets