Speaker Registration Form

October 9-12, 2016
The Fairmont Scottsdale Princess, Scottsdale, Arizona

Please complete this form and submit by Sept 2, 2016

For questions, please email [email protected]


    *required
    First Name *
    Last Name *
    Is this your first attendance at a Q Group Seminar?
    Nickname for badge *
    Title *
    Firm or Affiliation Name *
    Street Address *
    City *
    State *
    Zip or Postal Code *
    Country *
    Business Telephone *
    Cell Phone *
    Email *
    Confirmation Email to go to: *
    Will Your Spouse/Guest be Attending?
    Name for Badge Spouse/Guest
    Home City & State for Spouse/Guest
    Will you be staying at the Fairmont Scottsdale Princess?
    YesNo
    Alternate Hotel
    When will your PAPER be submitted for website posting? *
    When will your SLIDES be available for website posting? Deadline is Sept 9. *
    Will you be attending the following reception/dinners?
    Sunday evening
    YesNo
    Monday evening
    YesNo
    Tuesday evening
    YesNo

     

    captcha
    Thank You!