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 kstevens@q-group.org.

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?
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
Monday evening
Tuesday evening


Thank You!