Company Contact Name:
Company name:
Contact phone:
Contact email:
Check One:
Change
Cancellation
Name of Person
Name of Person attending
instead:
New Attendee Title:
New Attendee Telephone:
New Attendee email:
Note:  First change is complimentary.  All other changes incur a $75 administrative fee.
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
info@paymentconference.com
Amanda      309-762-2854 (CST)
Rose            714-774-4171 (PST)