2018 XSITE Planner Registration - Appointments and Education

This registration is for planners who wish to attend both the education program and lunch AND participate in the appointment reverse tradeshow.

If you have any questions, contact Allyson J. Deckman at (860) 541-6438 or mpicrv@gmail.com.

Please register by completing the form below. Registration is complimentary for qualified planners. You will receive a $50 AMEX Gift Card for participating and qualify for travel reimbursement. If you have any questions, contact Allyson J. Deckman at (860) 541-6438 or mpicrv@gmail.com.

Not a member of MPI? No problem! Non-MPI Planners are also welcome to register!

FOR EDUCATION AND LUNCH ONLY, PLEASE CLICK HERE 

XSITE PLANNER REGISTRATION (APPOINTMENTS & EDUCATION SESSIONS)

MPI CRV will contact you regarding the status of your registration to participate in the Appointment Trade Show. If you are not approved, you will have the opportunity to register for the Education and Luncheon portion of the program.

(* Denotes Required Fields)

Personal Information

First Name: *
Last Name: *
First Name for Badge:
Designation (if applicable):
Job Title: *
Company: *
Address: *
City: *
State: *
Zip Code: *
Phone: *
Fax:
Email: *
Membership: *
Primary Chapter: *
Pursuant to the American with Disabilites Act, do you require specific aid or services?
Special Needs:
Do you know of anyone that would be interested in learning more about MPI CRV?

Guest Information

EFFECTIVE JULY 1, 2016: Anyone who is not a preferred or premier level member is required to pay the non-chapter member rates for events and is limited to no more than 2 events in one fiscal year at the non-chapter member rate.
Will you be bringing a guest (charges apply as noted below): *  
Guest #1 First Name:
Guest #1 Last Name:
Guest's Membership:
Guest's First Name for Badge
Guest's Company:

Photo Release Statement

I give the MPI Connecticut River Valley Chapter, the absolute right and permission to use my photograph(s) in its promotional materials and publicity efforts. I understand that the photograph(s) may be used in a publication, print ad, direct-mail piece, electronic media (e.g. video, CD-ROM, Internet, World Wide Web), or other form of promotion for the Chapter. I release MPI CRV, the photographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use.
I have read and agree with the Photo Release Statement. *  

Donations

Would you like to make a donation to the MPI Foundation? If so, please enter the amount here: Amount: $

Payment and Cancellation Policy

  • Your Commitment to Attend XSITE: The Suppliers who have paid to attend this show and meet with you are relying on your participation and the completion of all assigned appointments.
  • Cancelling once appointment Match Making takes place or no-showing without notice impacts the success of the show and the investment of our participants.
  • By submitting your application (clicking on Done), you agree that you may be responsible for a $125 fee for a cancellation on or after March 9, 2018 or a no-show.
I have read and agree with the above Payment and Cancellation Policy. *  

Confirmation Email

Send Confirmation Email To: *


MPI CONNECTICUT RIVER VALLEY CHAPTER

701 Hebron Avenue - 3rd Floor
Glastonbury, CT 06033
Phone: 860.541.6438

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