EXHIBITORS:  Do not submit this form if you are registering someone
that is not an employee of your same company. Prior to registering
understand that our policy is
one (1) company to a booth only. If you
are not an employee of the company registered, your registration will
not be accepted.  We understand some companies have a parent
company. If your company has an individual website, your company
would need to register as an exhibitor individually. No partners, sister
companies, contractors, etc. Sorry, no exceptions.
Company Name:
Company Contact Name:
Company Contact email:
Company Address:
State:
Zip:
City:
Check One:
Registration
Complimentary Registration
Name
Phone:
1.
email:
Title:
Check here if first-time attendee. Provide name of person who referred you to our conference
2.
Phone:
Name:
email:
Title:
Check here if first-time attendee. Provide name of person who referred you to our conference
Phone:
3.
Name:
Title:
email:
Check here if first-time attendee. Provide name of person who referred you to our conference
Phone:
4.
Name:
email:
Title:
Check here if first-time attendee. Provide name of person who referred you to our conference
Check here if you will be mailing a check for payment. Address is on left
Check here if you need EFT information to make a payment.
Check here if making credit card payment.  Home Page has payment link. Note: Credit Cards incur an administrative fee.
Check here if you need an invoice
Check here if you need a receipt
Total # registering:
Add $25 per person if paying with credit card - non-refundable convenience fee.
Total Amount Due:
Code of Conduct, Cancellation and Change Policy
Prior to submitting your registration form, read the Code of Conduct,  Change and Cancellation and Waiver Information.  Your submitted
Registration Form indicates you have read, understand and accept all terms and conditions sited within the Conference Waiver Information.  
Photo Release
I/We hereby give the Utility Payment Conference and its delegated representatives the permission to photograph me alone and/or with other
attendees in conjunction with and for the conference.  I/We understand the pictures may be used for the promotion of the conference.  Publications
of photographs shall include, but is not limited to, the conference website, future conferences, promotional brochures and flyers and other forms of
media.
Liability Release Waiver Information
My/Our registration indicates I/We agree to release the Utility Payment Conference and hotel, and each of their respective officers, directors, agents,
representatives, and employees (referred to collectively as "Releasees") from any and all claims, actions, damages and liabilities, injury or loss that
in any way are caused by, arise out of or result from my participation in the Utility Payment Conference.
Hotel Reservation Release
I/We hereby give the Utility Payment Conference and its delegated representatives permission to inquire of the hotel information regarding my
booked reservation.  In addition, the conference hotel(s) has my/our permission to disclose my/our reservation information to the conference's
delegated representation.
www.paymentconference.com
Registration Cost Per Person for same Company employee - Add $25 for non-refundable credit card convenience fee per person
Note: Cancellations incur a administrative fee.

$750 - September 1 - October 15
Utility Payment Conference
Registration Information