Conference Substitution

Tell us about yourself

information for the person making this request

Company*

Name*

First Last

Business Email*

Who is the current registrant?

Current Attendee Name*

First Last

Who is joining us now?

New Attendee Name*

First Last

New Attendee Business Title*

New Attendee Business Email (email domain must match member company)*

New Attendee Business Phone*

New Attendee's Admin Email

Is this individual a first time attendee?*

Yes
No

Any dietary restrictions or other needs we should be aware of?

Emergency Contact Name*

First Last

Emergence Contact Phone*

Event Data Disclosure Agreement & Code of Conduct*

view the Event Data Disclosure Agreement & Code of Conduct

Yes, I have read and agree to the NASCIO Event Data Disclosure Agreement and Code of Conduct

COVID Protocols*

I affirm that I am either fully vaccinated for the COVID-19 virus (NASCIO encourages boosters but not required) OR, if not fully vaccinated I will obtain a negative PCR COVID-19 test within 72 hours of attending the 2022 Annual Conference

I have read and understand NASCIO's COVID protocols

COVID-19 Liability Waiver*

view the NASCIO COVID-19 Liability Waiver

Yes, I have read and agree to the NASCIO COVID-19 Liability Waiver