Leadership Mini-Conference Registration

Name

Institution/Organization

Email Address

Date of Event

Start and End Times of Event (including time zone)

Leadership Mini-Conference Deposit-Please select all that apply. Payment due in full by conference date.

SLC Overview Presentation (1 hr)-$2000/$50 deposit – $50

1 Specialty Presentation (1 hr)-$500 add-on/$50 deposit – $50

2 Specialty Presentations (2 hrs)-$1000 add-on/$100 deposit – $100

3 Specialty Presentations (3 hrs)-$1500 add-on/$150 deposit – $150

1 Consulting Session (1 hr)-$500 add-on/$50 deposit – $50

2 Consulting Sessions (2 hrs)-$1000 add-on/$100 deposit – $100

3 Consulting Sessions (3 hrs)-$1500 add-on/$150 deposit – $150

4 Consulting Sessions (4 hrs)-$2000 add-on/$200 deposit – $200

QA or Panel (1 hr)-$500 add-on/$50 deposit – $50

QA or Panel (30 minutes)-$250/$25 deposit – $25

Terms and Conditions

I agree to the Terms and Conditions listed at www.thegenzspeaker.com/terms/