Attendee Registration

Attendee First Name Attendee Last Name Title/Role Name as you would like it to appear on your badge (first and last names please) (and credentials if desired) Organization Name Address City State Zip Work phone Email (to be sent registration) Confirm Email Secondary Email (if registering on behalf of someone else) Confirm Secondary Email

How did you hear about this workshop?

Conference Registration Cancellation: Please let us know if your attendance status has changed by June 15th by emailing the NETRC team at netrc@mcd.org.

Consent to Use Photographic Images: Registration and attendance at or participation in this conference and related activities constitutes an agreement by the registrant to NETRC's use and distribution (both now and in the future) of the registrant's or attendee's image or voice in photographs, videotapes, electronic reproductions, and audiotapes of such events and activities.

Exceptions to this consent must be made in writing to netrc@mcd.org.

Health and Safety Acknowledgement: I agree to abide by all health, safety and social distancing guidelines required by event management, the event venue as well as local and state governments. I further acknowledge there are inherent risks of attending large gatherings for which event management is not liable.

Yes, I acknowledge