Conference Registration Form 2020 1 General Information2 Sponsor Registration3 ExhibitorRegistration4 General Registration5 Payment Section6 Confirmation General InformationEarly registration deadline is April 1, 2020. 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 RegistrationSponsorship RegistrationExhibitor Registration Sponsor RegistrationSponsor Name*Contact Name* First Last Sponsorship Benefits Diamond Sponsor - $5,500 Level Two Conference Admissions - $1,050 value One IRPT Membership - $825 value One Exhibit Booth - $1,500 value 2020-2021 Membership Directory Ad - $1,000 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 - $545 value Half Price Exhibit Booth - $750 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 LevelDiamond Sponsor - $5,500 LevelGold Sponsor - $3,500 LevelSilver Sponsor - $1,500 LevelWill you have an exhibit?*YesNo 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, April 20: Set-up begins at 10:00 am Tuesday, April 21: 8:00 am – 5:00 pm Wednesday, April 22: 8:00 am – 5:00 pm then breakdown Thursday, April 23: optional breakdown Each paid exhibitor will only have one complimentary admission to the conference, a $545 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 (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: $545.00 After April 1, 2020 the pricing will be $595.00Number of attendees (members)*Add quantity12345678910Excluding SpouseConference Attendee (non-members) Price: $595.00 After April 1, 2020 the pricing will be $645.00Number of attendees (non-member)*Add quantity12345678910Excluding SpouseConference Attendee (federal government employee) Price: $495.00 After April 1, 2020 the pricing will be $525.00Number 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 Monday Commissioner’s Track (port board commissioners)$100FREE with full conferenceSpouse/Guest Fee (Optional)Yes, my spouse will attend. Early $75NoAfter April 1, 2020, the pricing will be $100.00Spouse 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 ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Registration must be paid in full on or before April 1, 2020 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 - $5,500 receives (2) conference admissions $0.00 Diamond Sponsor - $5,500 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 - $5,500 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 - $5,500 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. This iframe contains the logic required to handle Ajax powered Gravity Forms.
