Register
First Name
*
Last Name
*
Email Address
*
Dates
*
November 8 - 11, 2020
Phone Number
*
Address
*
Street Address
Address Line 2
City
State
Zip
Organization
*
Title
*
Do you have any dietary restrictions?
*
No
Yes
Dietary Restrictions
LinkedIn Profile Link
*
If you do not have a LinkedIn profile, simply put http://linkedin.com
Headshot
Accepted file types: jpg, gif, png, pdf, tif.
Number of Participants
*
Please enter a number greater than or equal to
1
.
Will you be accompanied by your spouse?
Yes
No
Will your spouse participate in the event?
Yes
No
Additional Participants
We’ll email additional participants separately, requesting their headshot, bio, and social media.
Full Name
Email Address
Add VIP experience add-on for $497
*
Yes
No
Promo Code
Promo will only apply to VIP Add-on. Please make sure you have selected the VIP upgrade.
VIP Costs with Promo
Price:
$0.00
VIP Cost
Price:
$0.00
VIP Cost
Price:
$0.00
VIP Cost
Price:
$0.00
Correction
Price:
$497.00
Individual
Price:
$12,000.00
Individual
Price:
$12,000.00
Individual
Price:
$12,000.00
Price
$0.00
Credit Card
*
American Express
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Expiration Date
Security Code
Cardholder Name
Due to the nature of the event, there will be no refunds available. However, you can find someone to take your spot and do that by contacting
natalie@collideoscopeworld.com
If your spouse would like to attend with you, they are more than welcome to stay with you and take advantage of the resort amenities (spa, restaurant, bar, excursions) but would not be included in retreat-related activities or food and beverage.
For registration to be complete, payment must be paid in full at the time of registration.
You can register online, or email
Natalie Tsang
to request an invoice.
*
By submitting this form, you are accepting our
Terms and Conditions.
Event Details
Registration
Testimonials
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