Registration Form January 2018

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Conference Registration Form

HIDDEN FIGURES

WOMEN LEADERS ARE THE VOICE, THE CATALYST, THE FUTURE

Saturday, March 3, 2018

Online Registration, select registration type          

Registration Registration Date Reg. Amt. Online Service Charge Total Amount
Early Registration November 15th – December 15th $90.00 $5.00 $95.00
General Registration December 16th – February 15th $100.00 $5.00 $105.00
Networking Event – Wine Down November 15th – February 15th $30.00 $0 $30.00
Table Registration November 15th – January 15th
Table Group Members must register together, please enter names in the Registration Form below
$900.00 $45.00  $945.00

Listed below are the Speaker Sessions.

Please consider your 1st, 2nd and 3rd choices. Sessions have limited seating. We will try to grant your 1st choice.

Click HERE for larger image or pinch to zoom.

EmpowHer Reg TableA-cropped
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)

Email 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.


Paying by Credit or Debit card? Please note there will be no onsite registration!

Make your selection below and click on the BUY NOW Button.


Conference Registration




Paying By Check? Please note there will be no onsite registration!

The above offers close February 15th, 2018

Print your Confirmation Email and Mail with your check.
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.
Conference Registration is non-refundable.

Thank you for registering!

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