Conference Registration Form 2021 1General Information2Sponsor Registration3ExhibitorRegistration4General Registration5Payment Section6Confirmation General InformationEarly registration deadline is September 1, 2021. Company Name:* Name* First Last Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address:* Enter Email Confirm Email Phone Number:*Registration Type* General Registration Sponsor RegistrationSponsor Name* Contact Name* First Last Sponsorship Benefits Diamond Sponsor - $6,000 Level Two Conference Admissions - $1,250 value One IRPT Membership - $825 value One Exhibit Booth - $2,500 value 2020-2021 Membership Directory Ad - $1,500 value Full page advertisement in Conference Program Conference Banner Pre-Session Speaking Opportunity Program Listing Pre-Conference Acknowledgement Registration list 14-days prior Gold Sponsor - $3,500 Level One Conference Admission - $625 value Half Price Exhibit Booth - $1,250 value One Half Price IRPT Membership - $400 value Half price 2020-2021 Membership Directory Ad - $750 value Half page advertisement in Conference Program Conference Signage Pre-Conference Acknowledgement Program Listing Silver Sponsor - $1,500 Level Program Listing Conference Signage Pre-Conference Acknowledgement Sponsorship Level Diamond Sponsor - $6,000 Level Gold Sponsor - $3,500 Level Silver Sponsor - $1,500 Level Will you have an exhibit?* Yes No Exhibitor RegistrationExhibitors will be provided with a standard, skirted 8x8 trade show booth, 1 covered 6’ table and 2 chairs. Stand-alone exhibits are welcome with prior notice. Each booth includes electric and one conference admission. Exhibit cost is $2,500.00. Exhibit Times Monday, October 18: Set-up begins at 10:00 am Tuesday, October 19: 8:00 am – 5:00 pm Wednesday, October 20: 8:00 am – 5:00 pm then breakdown Thursday, October 21: optional breakdown Each paid exhibitor will only have one complimentary admission to the conference, a $625 value.Registrant Name* Company Name* Note - Diamond Sponsors receive (1) free exhibit booth. Gold Sponsors receive half price for (1) exhibit booth. These deductions will be adjusted at the end of the form.Exhibit Cost Price: Quantity*Add the exhibit1HiddenDo you accept the exhibit cost?*Add quantityNoYes Conference RegistrationI am going to be registered as:* Member Non-Member Federal Government Employee Select the total number of attendees (including yourself). Diamond Sponsors receive (2) free conference admissions. Gold Sponsors receive (1) free conference admission. These deductions will be adjusted at the end of the form..Conference Attendee (members) Price: After September 1, 2021 the pricing will be $675.00Number of attendees (members)*Add quantity12345678910Excluding SpouseConference Attendee (non-members) Price: After September 1, 2021 the pricing will be $725.00Number of attendees (non-member)*Add quantity12345678910Excluding SpouseConference Attendee (federal government employee) Price: After September 1, 2020 the pricing will be $600.00Number of attendees (federal government employee)*Add quantity12345678910Excluding SpouseName (Attendee #1)* First Last Name (Attendee #2)* First Last Name (Attendee #3)* First Last Name (Attendee #4)* First Last Name (Attendee #5)* First Last Name (Attendee #6)* First Last Name (Attendee #7)* First Last Name (Attendee #8)* First Last Name (Attendee #9)* First Last Name (Attendee #10)* First Last Spouse/Guest Fee (Optional) Yes, my spouse attend. Early $100 No After September 1, 2021 the pricing will be $150.00Spouse Name* First Last Payment SectionMethod of Payment* Check by Mail Credit Card Credit Card + 3% Convenience FeeCredit Card Address* Same as previous Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Registration must be paid in full on or before September 1, 2021 to avoid Late Registration Fee Please send payment to: IRPT: 4625 Lindell Boulevard Central West End, Suite 200 - #2179 St. Louis MO 63108 . Questions? Please call Aimee at 618-980-6523 or email aandres@irpt.netSubtotal $0.00 Diamond Sponsor - $6,000 receives (2) conference admissions $0.00 Diamond Sponsor - $6,000 receives (2) conference admissions $0.00 Diamond sponsor receives (1) exhibit booth $0.00 Gold Sponsor- $3,500 receives (1) conference admission $0.00 Gold sponsor receives half price exhibit booth $0.00 Each paid exhibitor will only have (1) complimentary admission to the conference $0.00 Diamond Sponsor - $6,000 receives (1) conference admission $0.00 Gold Sponsor- $3,500 receives (1) conference admission $0.00 Each paid exhibitor will only have (1) complimentary admission to the conference $0.00 Diamond Sponsor - $6,000 receives (1) conference admission $0.00 Gold Sponsor- $3,500 receives (1) conference admission $0.00 Each paid exhibitor will only have (1) complimentary admission to the conference $0.00 3% Credit Card Fee $0.00 Total $0.00 {all_fields}EmailThis field is for validation purposes and should be left unchanged.
