Personal Information

Fill out the information below, then click Next to continue.

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Registration Type

Attendee

* First name

Badge First Name

* Last name

* Email address

CC Email Address

* Company

* Title

Work Phone

* Mobile

Add a country code with the + if outside of US and Canada (e.g., +44). We'll use this for mobile login verification.

Work Address

* Address 1

Address 2

* Country/Region

USA

* City

* State/Province

* ZIP/Postal code

Insurity team member you were referred by:

Do you consent to have your contact information shared with our partner sponsors and vendors?

This question is required.

Yes, I consent
No, I do not consent

Additional Contact Details

Do you have any dietary restrictions?

This question is required.

Vegetarian
Gluten Free
Nut Allergy
Shellfish Allergy
Other
Not Applicable

If "Other," please provide details in the space provided.

ADA Requirements

Please provide details in the space provided.

* Emergency Contact Name

* Relationship

* Emergency Contact Phone Number

Terms and Conditions

* Photography and VideoThis question is required.

By completing this registration, you understand that you and your guest if applicable may be photographed, taped or recorded during the Conference and that you grant the Conference permission to use your image or voice in all forms and media as permitted by law. You waive the right to inspect or approve versions of your image or voice or the written copy that may be used in connection with either.

* Privacy PolicyThis question is required.

During the process of providing you services , Insurity may collect, store, or transmit your personal identifiable information such as name, address, contact information, preferences, demographic information, as well as any hotel or travel requests you provide us. This information is necessary for the facilitation of Registration services for you. This information may be shared with other 3rd parties, such as event organizers, planners, affiliated organization, and travel or lodging providers. Should you wish to manage the information entrusted to Insurity, you can do so at info@insurity.com.

* Health & Safety StatementThis question is required.

By registering, you acknowledge the contagious nature of COVID-19 and related variants and voluntarily assume all related risks by attending the Conference, including that such exposure or infection may result in loss, liability, expense, injury, disability, or death. You acknowledge and voluntarily assume the risk of being exposed to or infected by COVID at the Conference may result from the negligence, actions, or omissions or others who attend the Conference. You release, waive, and forever discharge any and all liability, claims, and demands of whatever kind or nature against the Conference, including, without limitation, its directors, officers, employees, agents, and volunteers (the “Released Parties”), either in law or in equity, to the fullest extent permissible by law, including but not limited to damages or losses caused by the negligence, fault, or conduct on the part of the Released Parties, including but not limited to death, bodily injury, illness, economic loss or out of pocket expenses, or loss or damage to property.

Hotel Accommodations

After completing your registration, you will receive instructions to make guestroom reservations at the OMNI Fort Lauderdale.

Instructions will be found on your confirmation page as well as your confirmation email.

Please note that on Monday, October 5th the main conference will begin with an opening keynote at 5 pm. User Group sessions will be held from 1 - 4 pm. The final session ends Wednesday, October 7th at 11:30 am.

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