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Conference Registration Form

Double X FactorSaturday, May 4, 2019


Join us for one full day of content-rich sessions and learn how to accelerate success, gain empowerment
and create your own personal action plan to move you to your next level of success.

PLEASE NOTE OUR CANCELLATION/REFUND POLICY

  • Registrations are non-refundable.
  • Cancellations or no-shows (regardless of the reason) are non-refundable. No exceptions.
  • Please note your registration can be transferred to another person to attend the conference.

General Registration Includes:

Access to all keynote sessions

Access to all breakout sessions

Continental Breakfast and Smoothie Bar

Lunch Includes salad, entrée and desert

Closing Network Reception/Book Signing

Access to conference replays for 14 days

Review Conference Sessions below, scroll down for registration form.

    We thank you for your interest in participating in our conference! Fill in our online Conference Registration Form below to receive your badge and the schedule for the entire event.

    Attendee’s Name (required)

    Preferred Name on Conference Badge (required)

    Company/Organization (required)

    Home Phone Number (required)

    Mobile Phone Number (required)

    Your Email (required)

    You will receive your receipt of the fully completed registration form along with other conference updates and newsletter.

    Mailing Address (required)

    City (required)

    State (required)

    ZIP (required)

    Select Your Career/Industry (required)

    Select Your Age Range (required)


    How did you hear about conference? (required)

    Any Special Accommodations?

    What do you expect to get out of the conference?



    Are you Booking a Table? Please enter the names of your group members here. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

    Please select your 1st, 2nd and 3rd choices from the table (above) and enter in the dropdown lists below. Sessions have limited seating. We will try to grant your 1st choice.

    Session 1

    First Choice:

    Second Choice:

    Third Choice:

    Session 2

    First Choice:

    Second Choice:

    Third Choice:

    Session 3

    First Choice:

    Second Choice:

    Third Choice:

    Conference Registration is non-refundable. After you click SEND, please select your payment below.



    Closes April 25, 2019 – $105.00 – General Registration

    (Please note no registration will be available on site!)

    All credit card payments online are subject to a processing fee.
    Checks must be postmarked by the noted deadline in order to receive the applicable rate.
    Checks can be mailed to:
    EmpowHER of the Palm Beaches, Inc.
    P.O. Box 2717, West Palm Beach, FL 33402

    Online Registration Method, select registration type: PayPal logo for site


    Conference Registration


    Print Form and Mail Registration
    Enclose check payable to EmpowHER of the Palm Beaches, Inc. and mail to:

    EmpowHER Conference Registration
    P.O. Box 2717
    West Palm Beach, FL 33402

    You will receive a Confirmation and Receipt at your Email address above.
    Checks must be postmarked by the noted deadline in order to receive the applicable rate.

    Thank you for registering!