MEPC Registration Form

*** REGISTRATION FOR THE 2020 CONFERENCE IS NOT OPEN YET ***
Type of Registration*
Select Day*
PROMO CODE
Is this your first time attending MEPC?*
- No
- Yes
If this is your first time attending, please enter the name of the person who referred you under "How did you hear about the MEPC?" section below.
How did you hear about the MEPC?
Registrant Information
Name*
First Last
Name on Badge*
Job Title or description*
Organization*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Registrant Email*
Enter Email Confirm Email
Cc Email
Enter Email Confirm Email
Golf Outing
Would you like to register for the golf outing on Thurday 7/25/19?
- Yes. I would like to register for the golf outing.
Name #1 ($130)
First Last
Name #2 ($130)
First Last
Name #3 ($130)
First Last
Name #4 ($130)
First Last
Name #5 ($130)
First Last
Register Additional Guests
*A Registered Guest can attend all conference events such as receptions and meals but are not permitted into the conference sessions. If your Guest would like to attend the conference sessions, they will need to register as a General Attendee.
Would you like to register additional guests?
- Yes. I would like to register additional guests.
Guest #1 ($170) - Name
First Last
Guest #2 ($170) - Name
First Last
Guest #3 ($170) - Name
First Last
Guest #4 ($170) - Name
First Last
Guest #5 ($170) - Name
First Last
Guest #6 ($170) - Name
First Last
Register Children
Would you like to register any children? (17 and under)
- Yes. I would like to register children
Child #1 ($50) - Name
First Last
Age
Child #2 ($50) - Name
First Last
Age
Child #3 ($50) - Name
First Last
Age
Child #4 ($50) - Name
First Last
Age
Child #5 ($50) - Name
First Last
Age

Reception Information
Number Attending Wednesday Reception*
Number Attending Thursday Cocktail Reception*
Would you like to register for Thursday evening's Children’s Program?
PLEASE NOTE: Children MUST BE between the ages of 5-12 and Registered for the Conference in order to participate in the Children's Program.
- Yes. I would like to register for Thursday evening's Children’s Program.
Child #1 ($5) - Name
First Last
Age*
Child #2 ($5) - Name
First Last
Age*
Child #3 ($5) - Name
First Last
Age*
Child #4 ($5) - Name
First Last
Age*
Child #5 ($5) - Name
First Last
Age*

Step 1 of 3

Registrant Information

Golf Outing

Register Additional Guests

Register Children

Reception Information

Terms and Conditions

Payment Options

Special Needs

Emergency Contact