Registration

 


 Registrant Information: (All fields are required*)
First Name:
Last Name:
Title:
Organization:
   
Email Address:
Phone Number: (xxx)-xxx-xxxx
   
   
Street Address:
City:
State:
Zip:

 


Attendee 1


Same as Registrant
First Name:
Last Name:

Title:
Organization:
Phone:
Email Address:

Accessibility Accommodations:
ASL Interpreter
CART
Large Print Guidebook
Wheelchair Access
Service Animal Accomodations
Food Allergies
Other:
Lunch Selection:


 

 Billing Information (required)
  Same as Registrant
First Name:
Last Name:
Company (optional):
Street Address:
Street Address (2):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
 
 Credit Card (required) Pay by Check or PO
Credit Card Number:
Expiration Date: /
Security Code



I/We Agree

Cancellation Policy: You may designate a substitute in writing at any time prior to the event. Cancellation requests must be made in writing and sent via email or fax and will be subject to a $75 processing fee. No cancellations will be accepted within two weeks of conference date. Conference no-shows will be liable for entire registration fee. In the rare event of a cancellation of an event, enableUS will reimburse full registration fees, reimbursement is limited to registration fee only.




 

Privacy Contact Information

If you have any questions, concerns, or comments about our privacy policy you may contact us using the information below:

 

enableUS
181 Harvard Street, Suite 1
Cambridge, MA 021396

Phone: 703-894-7414
Fax: 703-964-9891

Email: info@enableus.org

 

We reserve the right to make changes to this policy. Any changes to this policy will be posted.


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