Spring 2016 Speaker Registration Form

April 17–20, 2016
The Fairmont Washington, D.C., Georgetown

Please complete this form and submit by March 2, 2016

For questions, please email kstevens@q-group.org.


Full Name *
*required
Nickname for badge *
Title *
Firm or Affiliation Name *
Street Address *
City *
State *
Zip or Postal Code *
Country *
Business Telephone *
Cell Phone *
Email *
Will Your Spouse/Guest be Attending?
Name for Badge Spouse/Guest
Home City & State for Spouse/Guest
Please indicate your ARRIVAL and DEPARTURE dates *
Will you be staying at the Fairmont Washington D.C. Georgetown?
YesNo
If NO, what is the name of the hotel where you will be staying?
When will your PAPER be submitted for website posting? *
When will your SLIDES be available for printing and website posting? Deadline is March 17. *
Will you be attending the following reception/dinners?
Sunday evening
YesNo
Monday evening
YesNo
Tuesday evening
YesNo

 

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Thank You!