Registered Company Name and Contact Information Form
Note: Do not submit this form unless the UPC has asked you to do so.
Company
Contact person's  Name:
NOTE:  
Contact information refers to
person we would contact if
we had questions regarding
the registration(s).
Company
Contact person's  Title:
Company
Contact person's  email:
Company
Contact person's  Phone:
Company
Name:
Address:
City:
State:
Zip:
Complimentary Staff Registration Information
Information is same as above
1.
Name:
Title:
Phone:
email:
Check here if first time attendee
2.
Name:
Title:
Phone:
email:
Check here if first time attendee
Registration Compliance Information
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.
Cancellation and Change Policy
My/Our submitted registration form indicates I/We have read, understand and agree to the conference Cancellation and
Change Policy.  
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
Please provide us with your company name and the name of the person from your company registering.
Utility Payment Conference