Media & Spouse Registration – Credit Card

Publication

Company Name *

Media Representative Information

First Name *

Last Name *

Title *

e.g. Manager, President, Owner

Name Badge *

First name as you would like it to appear on your name badge

Business Contact Information

Address *

City *

State or Province *

Zip or Postal Code *

Phone *

Email *

Spouse Information

First Name *

Last Name *

Name Badge *

First name as you would like it to appear on your name badge.

Spouse's Residential Address & Contact Information

Address *

City *

State or Province *

Zip or Postal Code *

Phone *

Email *

Conference Registration Fee

Conference Information

Arrival Date *

Friday – May 31, 2024
Saturday – June 1, 2024
Sunday – June 2, 2024
Monday – June 3, 2024

Departure Date *

Monday – June 3, 2024
Tuesday – June 4, 2024
Wednesday – June 5, 2024
Thursday – June 6, 2024
Friday – June 7, 2024

Dining Reservations

Please check the boxes to indicate which dinners you will be attending.

Monday Dining Preference *

Attending
Not Attending

Tuesday Dining Preference *

Attending
Not Attending

Wednesday Dining Preference *

Attending
Not Attending

Please list any food allergies or dietary practices in the box below:

Dietary Practices

All dining arrangements will be confirmed with this registrant closer to the event.

Billing

Total:

$0.00

Name on Credit Card *

First

Last

Credit Card *

Card Number

Expiration

Security Code

An email confirmation will be sent to the email address entered on this form. A receipt of your online payment will be sent to the same email address. Click the “Submit Registration” button below to complete your registration.