Conference Registration
First Name (*)
Please enter your first name.
Last Name (*)
Please enter your last name.
Badge Name (*)
Please enter your name as you want it displayed on your name badge.
Please enter your name as you want it displayed on your name badge.
Spouses Name (If attending)
Please enter your spouses name.
Company (*)
Please enter your company name.
Address (*)
Please enter your address.
Suite
Please enter your suite number.
City (*)
Please enter the city name your company is located in.
State (*)
Please select your state.
Zip Code (*)
Please enter your zip code (first 5 digits only).
Phone Number (*)
Please enter your phone number.
Toll-Free
Please enter your toll-free phone number.
Fax Number
Please enter your fax number.
Cell Phone
Please enter your cell phone number.
Do you want your cell phone number published in the conference attendee list?
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Email Address (*)
Please enter your email address.
Early-bird or Standard Registration? (*)




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Number of additional Attendees:
Please select how many additional attendees you will be registering.
Please select how many additional attendees you will be registering ($200/each).
Additional Attendee - Name
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Address, City Zip Code (If Different)
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Direct Line
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Email:
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Cell Phone
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Additional Attendee - Name
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Address, City Zip Code (If Different)
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Direct Line
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Email:
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Cell Phone
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Additional Attendee - Name
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Address, City Zip Code (If Different)
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Direct Line
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Email:
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Cell Phone
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Additional Attendee - Name
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Address, City Zip Code (If Different)
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Direct Line
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Email:
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Cell Phone
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If Exhibiting, do you need electricity or internet?
Please select if you need electricity or internet.
Exhibitor Promotional Piece
Please enter a promotional piece for your company if you are exhibiting.
If you are exhibiting, please use the space beside this text to insert your 50-150 word promotional text that will be in the exhibitor piece at the conference.
Are you interested in
Sponsorship Opprotunities?








Please make sure to submit your logo, if you are sponsoring. Your logo will be posted in front of the reception room.
Payment Method (*)




Please select your payment method.
Credit Card Number
Please enter your credit card number without dashes.
Please enter your credit card number without dashes.
Name on Card
Please enter the name on the credit card.
Expiration Date
Please enter the expiration date of your credit card.
Billing Address
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City
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State
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Billing Zip Code
Please enter the billing zip code for your credit card.
Terms and Conditions (*)
You must accept the terms presented to register online.
By clicking here, I understand that CVTA will charge my credit card for the above checked items (if selected). If a mistake is discovered, I can contact CVTA and make arrangements to cancel or modify the charges.
Please enter the numbers you see in
the box to verify that you are not a spammer. (*)
Please enter the <strong>numbers</strong> you see in<br> the box to verify that you are not a spammer.
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