Influencer LIVE!
Registration Agreement
Nov. 1 or Nov. 2, 2007

Part A: Individual Registrant or Person Registering Group

Event Information

Please select the date and location you plan to attend:

Title *

Name *

Phone *

Organization *

Address 2

Address 1 *

City *

Email *

Zip *

State *

How did you hear about it? *

Promotional Code:

Association:

Part B: Additional Attendees

List price is $95, with discounted rates for groups as follows.

Please select a rate for your tickets:

How many tickets would you like to purchase for people in your organization? *

Part C: Payment Information

For questions, please call Laura Lyon at 801.553.0065.

Payment by Credit Card

Credit Card Number

Credit Card Exp. Date (i.e. 0209)

Full Name on Card

Please Invoice Me

Invoice Registrant Above

Invoice the following

Title

Name

Phone

Organization

Address 1

Fax

Address 2

State

City

Zip

Event Cancellation Policy

Cancellations received up to five (5) working days before the event are refundable. (Credit card cancellations will be charged a 3.5% processing fee.) Within five days of the event, cancellations are subject to the entire cost of the ticket. Please note that if you do not cancel and do not attend, you are still responsible for payment. Should you find yourself unable to attend within the five working days prior to the session, you may send a substitute.

By sending in this form, I acknowledge and accept all payment terms and cancellation policies of this agreement.

You will be sent tickets and a confirmation email once your registration is received.