Conference Registration Form - 2019 1 General Information2 Sponsor Registration3 ExhibitorRegistration4 General Registration5 Payment Section6 Confirmation General InformationEarly registration deadline is April 1, 2019. 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:*WebsiteSelect one of the following options:*Sponsor RegistrationGeneral Registration Sponsor RegistrationSponsor Name*Contact Name* First Last Sponsorship Benefits Diamond Sponsor - $5,000 Level One Conference Admissions - $500 value Half Conference Admission for 1 Additional Attendee One IRPT Membership - $750 value One Exhibit Booth - $1500 value 2019-2020 Membership Directory Ad - $1000 value Full page advertisement in Conference Program Conference Banner Pre-Session Speaking Opportunity or Video Pre-Conference Acknowledgement Registration list 14-days prior Gold Sponsor - $3,500 Level One Conference Admission - $500 value Half Price Exhibit Booth - $750 value Half price 2019-2020 Membership Directory Ad - $750 value Half page advertisement in Conference Program Conference Signage Pre-Conference Acknowledgement Silver Sponsor - $1,500 Level Program Listing Conference Signage Pre-Conference Acknowledgement Sponsorship Level*Diamond Sponsor - $5,000 LevelGold Sponsor - $3,500 LevelSilver Sponsor - $1,500 Level 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 $1,500.00. Exhibit Times Monday: Set-up begins at 10:00 am – 5 pm (hall is open during these hours, but it is not necessary to be there the entire time), reception following; Tuesday: 8:00 am – 5:00 pm, reception following; Wednesday: 8:00 am – 5:00 pm reception following; Thursday: 8:00 am – 12 noon Exhibitors break down beginning at 10:30 am – conference ends at 12:00 noon Each paid exhibitor will only have one complimentary admission to the conference, a $500 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: $1,500.00 Quantity*Add the exhibit1Do you accept the exhibit cost?*Add quantityNoYes Conference RegistrationI am going to be registered as:*MemberNon-MemberFederal Government EmployeeSelect the total number of attendees (including yourself). Diamond Sponsors receive (1) free conference admission and half price on the second conference admission. Gold Sponsors receive (1) free conference admission.These deductions will be adjusted at the end of the form.Conference Attendee (members) Price: $500.00 After April 1, 2019 the pricing will be $575.00Number of attendees (members)*Add quantity12345678910Excluding SpouseConference Attendee (non-members) Price: $575.00 After April 1, 2019 the pricing will be $625.00Number of attendees (non-member)*Add quantity12345678910Excluding SpouseConference Attendee (federal government employee) Price: $425.00 After April 1, 2019 the pricing will be $450.00Number 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 will attend. Early $75NoAfter April 1, 2019, the pricing will be $100.00Spouse Name* First Last Special EventsPlease advise if you will attend – Spouse/Guest must pay fee (above) to participateSelect if you are attending: Monday night reception: Monday, April 22nd (No Cost) Monday night reception: Monday, April 22nd Price: $0.00 Quantity*Add quantity12345678910 Payment SectionMethod of Payment* Check by Mail Credit Card Credit Card + 3% Convenience FeeCredit Card 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 Must match Credit Card billing addressCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Registration must be paid in full on or before April 1, 2019 to avoid Late Registration Fee Please send payment to: IRPT: One Confluence Way, East Alton, IL 62024. Questions? Please call Aimee at 618-468-3010 or email admin@irpt.netSubtotal $0.00 Diamond Sponsor - $5,000 receives (1) conference admission $0.00 Diamond Sponsor - $5,000 receives half price conference admission $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 - $5,000 receives (1) conference admission $0.00 Diamond Sponsor - $5,000 receives half price 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 - $5,000 receives (1) conference admission $0.00 Diamond Sponsor - $5,000 receives half price 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}PhoneThis field is for validation purposes and should be left unchanged. 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