Connect 2022

Please complete the following questions to register for Connect 2022 in San Diego, CA

First Name as you'd like it to appear on conference materials *This question is required.

Last Name *This question is required.

Company *This question is required.

Title

E-mail *This question is required.

Office Phone:

Cell Phone: *This question is required.

1. Do you any food allergies or special dietary needs that we should be aware of?

2. Please indicate which of the following activities you would like to participate in.

Tuesday, June 7 from 6:00 p.m. - 9:00 p.m.
High Spirits Yacht Cruise
Dinner and drinks included

Wednesday, June 8 from 6:00 p.m. - 9:00 p.m.
Punch Bowl Social
Dinner, drinks and games included *This question is required.

Yacht Cruise
Punch Bowl Social
Both
Neither

3. Will you need hotel accommodations during the conference?
We have a block of rooms reserved at The Hard Rock Hotel, 207 Fifth Ave., San Diego, CA 92101. Your Connect 2022 registration includes overnight accommodations for arrival on Monday, June 6 and departure on Thursday, June 9. Please contact Sara Carson (sara.carson@accidentfund.com) if you prefer (or need) to pay for the accommodations yourself, and we will make your arrangements accordingly. *This question is required.

What is your check in date?

Your Connect 2022 registration includes accommodations with arrival on Monday, June 6 and departure on Thursday, June 9; however, if you would like to extend your stay for personal reasons, The Hard Rock Hotel will extend the promotional rate to you for $209/room per day (plus taxes) and a $15/day resort fee from June 4 - June 10 (based on availability). *This question is required.

What date will you check out of the hotel?

(If you would like to extend your stay for personal reasons, The Hard Rock Hotel will offer the promotional rate from June 4 - June 10. The rate is $209/room per day (plus taxes) and a $15/day resort fee, based on availability.) *This question is required.

4. Emergency Contact Name *This question is required.

5. Emergency Contact Phone Number *This question is required.

*These questions are required.

Thank you!