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Consultant Registration Form

Online registration will be open through January 15. Registrations will also be accepted on-site at the conference. All conference attendees receive a printed copy of the Attendee Directory. Please note that those who register by December 31 will appear in the directory; those who register on January 1 or later will appear in a PDF that will be provided to attendees immediately after the conference.

Organization Information & Registration Details
Organization*
(Please list organization name as you wish for it to appear in publications) Error Required.Exceeded maximum number of characters.
Affiliate Status

Consultant fees have not changed from 2009!

Are you a CASE Affiliate?*
Yes
 $500
No
 $700



Subtotal of Fees:

Contact Information
Address 1*
Error
Address 2
City*
Error		 State/Province* Error Zip/Postal Code* Error
Contact Person*
Error
Email*
Error Required.Error Invalid format.
Phone*
Error		 Fax
Web Site Address*
www. Error Required.
Company Description
Please submit a company description to appear in the conference program. The description will be included EXACTLY as it reads. Please also list the names and titles of your representatives. This information will be published in the booklet EXACTLY as you present it to us.

Name(s) and Title(s) of Representatives attending the conference:
Rep 1 Name
Error 		 Title
Error		 Email
ErrorErrorEmail format.Error
Rep 2 Name
 Title
 Email
Additional representatives are $300 each:
Rep 3 Name
 Title
 Email
Rep 4 Name
 Title
 Email
Rep 5 Name
 Title
 Email
Rep 6 Name
 Title
 Email
Rep 7 Name
 Title
 Email
Rep 8 Name
 Title
 Email
Rep 9 Name
 Title
 Email
Rep 10 Name
 Title
 Email
Additional Representative Total: $

Raffle Items:
Are you willing to supply a raffle item for our Exhibitor Passport/Raffle Drawing?
Description of item(s)  

District I Awards Celebration on Wednesday Evening—$50 per person
1) Name
 2) Name
3) Name
 4) Name
5) Name
 6) Name
7) Name
 8) Name
9) Name
 10) Name
Note to Diamond & Platinum Sponsors - 2 Guests are included with your sponsorship.
Total: $

 

Your Total: $
Payment Method: Check       Credit Card

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