Immediate Payments User Conference Registration

Registrant Information

First Name

Last Name

Title

Credit Union

Routing/Transit Number (R/T)

City/State

Will you be seeking CPE credits?

Special Requests

Which evening networking events will you be attending? Monday Welcome Reception Tuesday Night Social Gathering

Hotel Stay

Are you staying at the AC Hotel?

Emergency Contact

Cell Phone

Emergency Contact Name

Emergency Contact Phone Number

Guest Registration for Evening Events ($50 per event)

Will you have a guest attending any evening events?

Payment Information

Register by May 29 to take advantage of the early bird rate of $300 per registrant. After May 29, the standard registration fee will be $375. Guest registration for each event is $50 per guest.

Payment Method

Payment Authorization By checking this box, I accept these charges and agree to the selected payment method.