January Event Registration Form

Name*

Business Name*

Email Address*

example@example.com

Phone Number*

Area Code Phone Number

Member Status*

Affirmed or Affiliated MemberEmployee MemberNon-Member

Note: Employee prices apply to employee members when their employer (affirmed member) is also attending the event.

Days Attending*

Friday Only - In PersonSaturday Only - In PersonBoth Days - In PersonOnline Only (one or both days)

Are you participating online? Please include the email address you use to sign on to Zoom (if different from above).

Also, we will be mailing the event package (including a soft copy of seminar documents) to all online participants so please include your preferred mailing address

Email address for Zoom

example@example.com

Preferred mailing address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Seminar Documents: Everyone will receive a soft copy of all seminar documents on a USB drive. If you would like to receive a hard copy, there will be a charge of $25

Seminar Documents

Hard Copy ($25)

Food Allergies or other information we need to make the event accessible for you

Privacy and Permissions: Speakers and sponsors make these events possible and affordable, in exchange, they would like the opportunity to reach out to you with information about their products and services. As a participant in this event, we encourage you to give them access to your email. You will have the option to unsubscribe from further messages after the first one.

I give ATAP permission to share my email address*

With SpeakersWith SponsorsI do not give permission to share my email address

Participant 1 - Sub-Total

Participant 1 - Total

Name*

Email*

example@example.com

Member Status*

Employee MemberNon-MemberSpouse

Note: Employee prices apply to employee members when their employer (affirmed member) is also attending the event.

Days Attending*

Friday Only - In PersonSaturday Only - In PersonBoth Days - In PersonOnline Only (one or both days)

Are you participating online? Please include the email address you use to sign on to Zoom (if different from above).

Also, we will be mailing the event package (including a soft copy of seminar documents) to all online participants so please include your preferred mailing address

Email used for Zoom meetings

example@example.com

Preferred Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Seminar Documents: Everyone will receive a soft copy of all seminar documents on a USB drive. If you would like to receive a hard copy, there will be a charge of $25

Seminar Documents

Hard Copy ($25)

Spouse Extras

Friday & Saturday- Breakfast & Lunch (+$110)

Food Allergies or other information we need to make the event accessible for you

Privacy and Permissions: Speakers and sponsors make these events possible and affordable, in exchange, they would like the opportunity to reach out to you with information about their products and services. As a participant in this event, we encourage you to give them access to your email. You will have the option to unsubscribe from further messages after the first one.

I give ATAP permission to share my email address*

With SpeakersWith SponsorsI do not give permission to share my email address

Participant 2 - Sub-Total

Participant 2 - Total

Name*

Email*

example@example.com

Member Status*

Employee MemberNon-MemberSpouse

Note: Employee prices apply to employee members when their employer (affirmed member) is also attending the event.

Days Attending*

Friday Only - In PersonSaturday Only - In PersonBoth Days - In PersonOnline Only (one or both days)

Are you participating online? Please include the email address you use to sign on to Zoom (if different from above).

Also, we will be mailing the event package (including a soft copy of seminar documents) to all online participants so please include your preferred mailing address

Email address for Zoom

example@example.com

Preferred mailing address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Seminar Documents: Everyone will receive a soft copy of all seminar documents on a USB drive. If you would like to receive a hard copy, there will be a charge of $25

Seminar Documents

Hard Copy ($25)

Spouse Extras

Friday & Saturday- Breakfast & Lunch (+$110)

Food Allergies or other information we need to make the event accessible for you

Privacy and Permissions: Speakers and sponsors make these events possible and affordable, in exchange, they would like the opportunity to reach out to you with information about their products and services. As a participant in this event, we encourage you to give them access to your email. You will have the option to unsubscribe from further messages after the first one.

I give ATAP permission to share my email address*

With SpeakersWith SponsorsI do not give permission to share my email address

Participant 3 - Sub-Total

Participant 3 - Total

Name*

Email*

example@example.com

Member Status*

Employee MemberNon-MemberSpouse

Note: Employee prices apply to employee members when their employer (affirmed member) is also attending the event.

Days Attending*

Friday Only - In PersonSaturday Only - In PersonBoth Days - In PersonOnline Only (one or both days)

Are you participating online? Please include the email address you use to sign on to Zoom (if different from above).

Also, we will be mailing the event package (including a soft copy of seminar documents) to all online participants so please include your preferred mailing address

Email address for Zoom

example@example.com

Preferred mailing address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Seminar Documents: Everyone will receive a soft copy of all seminar documents on a USB drive. If you would like to receive a hard copy, there will be a charge of $25

Seminar Documents

Hard Copy ($25)

Spouse Extras

Friday & Saturday- Breakfast & Lunch (+$110)

Food Allergies or other information we need to make the event accessible for you

Privacy and Permissions: Speakers and sponsors make these events possible and affordable, in exchange, they would like the opportunity to reach out to you with information about their products and services. As a participant in this event, we encourage you to give them access to your email. You will have the option to unsubscribe from further messages after the first one.

I give ATAP permission to share my email address*

With SpeakersWith SponsorsI do not give permission to share my email address

Participant 4 - Sub-Total

Participant 4 - Total

Name*

Email*

example@example.com

Member Status*

Employee MemberNon-MemberSpouse

Note: Employee prices apply to employee members when their employer (affirmed member) is also attending the event.

Days Attending*

Friday Only - In PersonSaturday Only - In PersonBoth Days - In PersonOnline Only (one or both days)

Are you participating online? Please include the email address you use to sign on to Zoom (if different from above).

Also, we will be mailing the event package (including a soft copy of seminar documents) to all online participants so please include your preferred mailing address

Email address for Zoom

example@example.com

Preferred mailing address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Seminar Documents: Everyone will receive a soft copy of all seminar documents on a USB drive. If you would like to receive a hard copy, there will be a charge of $25

Seminar Documents

Hard Copy ($25)

Spouse Extras

Friday & Saturday- Breakfast & Lunch (+$110)

Food Allergies or other information we need to make the event accessible for you

Privacy and Permissions: Speakers and sponsors make these events possible and affordable, in exchange, they would like the opportunity to reach out to you with information about their products and services. As a participant in this event, we encourage you to give them access to your email. You will have the option to unsubscribe from further messages after the first one.

I give ATAP permission to share my email address*

With SpeakersWith SponsorsI do not give permission to share my email address

Participant 5 - Sub-Total

Participant 5 - Total

Name*

Email*

example@example.com

Member Status*

Employee MemberNon-MemberSpouse

Note: Employee prices apply to employee members when their employer (affirmed member) is also attending the event.

Days Attending*

Friday Only - In PersonSaturday Only - In PersonBoth Days - In PersonOnline Only (one or both days)

Are you participating online? Please include the email address you use to sign on to Zoom (if different from above).

Also, we will be mailing the event package (including a soft copy of seminar documents) to all online participants so please include your preferred mailing address

Email address for Zoom

example@example.com

Preferred mailing address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Seminar Documents: Everyone will receive a soft copy of all seminar documents on a USB drive. If you would like to receive a hard copy, there will be a charge of $25

Seminar Documents

Hard Copy ($25)

Spouse Extras

Friday & Saturday- Breakfast & Lunch (+$110)

Food Allergies or other information we need to make the event accessible for you

Privacy and Permissions: Speakers and sponsors make these events possible and affordable, in exchange, they would like the opportunity to reach out to you with information about their products and services. As a participant in this event, we encourage you to give them access to your email. You will have the option to unsubscribe from further messages after the first one.

I give ATAP permission to share my email address*

With SpeakersWith SponsorsI do not give permission to share my email address

Participant 6 - Sub-Total

Participant 6 - Total

Sub-Total

Taxes

Total Due

Payment Options*

Pay by Credit CardPay By Cheque

Order Total

CADDescription

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Participant 2:

Participant 3:

Participant 4:

Participant 5:

Participant 6: