Conference Attendee Company Name:
Conference Attendee Name:
Conference Attendee Phone:
Conference Attendee email:
Guest Name:
Check the appropriate box below:
$40  Social Hour; beverages and appetizers
Monday, October 16
$40  Breakfast
Thursday, October 19
Total
Due
:
NOTE: No refunds once your registration and payment is submitted
Payment Option
Check here if you will be paying in person.
Check here if you are paying with your American Expresss, Discover, MasterCard or Visa
card.
Note: Card payment link is on our Home Page.
My registration submittal indicates I accept the terms of the Cancellation and
Waiver information and accept it as written as it applies to my attendance to
the Conference.
Thank you for your interest in bringing a guest to our conference.  We have a few items you need to be
aware of prior to registering your guest.  They are as follows:
1.  No guests are allowed at any conference sessions
2.  Guests must be 21 years or older
3.  Your guest may not be a business associate
  •      An eligible guest is a spouse, significant other or relative
Submit this form electronically, and submit your payment via credit/debit card. You may also pay cash in
person at check-in.
Your guest is invited to attend our social hour on Monday and/or our Thursday breakfast buffet.  Guests must be
at least 21 years of age to attend.  

He/She will receive a badge that must be worn at each event they attend.  
www.paymentconference.com
Amanda      309-762-2854 (CST)
Rose            714-774-4171 (PST)