Tickets - Mossier

Instructions

Please fill out the following form to register for Proud to Work Conference tickets. The Proud to Work Conference will take place on June 25th at the Radisson Blu, Mall of America, and is a separate event from the Proud to Work Career Fair on June 26th. Please note: All attendee information must be submit at time of ticket purchase. Tickets cannot be purchased with incomplete attendee details. If the ticket purchaser is also attending the Conference, please note that they will need to re-enter their information as an attendee in the “ticket information” portion of this form.

Point of Contact

This is the person purchasing ticket(s), and is distinct from the attendees. If the point of contact is also attending, please re-enter their information under "ticket information".

Name*

First Last

Email*

Phone*

Company Name*

Title*

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Early Bird I (until April 1st )

Price: $249.00 Quantity:

Early Bird II (until May 15th )

Price: $349.00 Quantity:

Full Corporate Rate (until event)

Price: $399.00 Quantity:

Nonprofit / Government Rate

Price: $195.00 Quantity:

Ticket Information

Please note: All attendee information must be submit at the time of ticket purchase. Tickets cannot be purchased with incomplete attendee details.

Number of Participants

Select number of participants to enter information for.

Enter Participant Information Below

Name*

First Last

Email

Company Name*

Title*

Pronouns*

Pronouns write-in

Write your pronouns here.

Do you have dietary restrictions or needs?

Vegetarian
Vegan
Gluten Free
Kosher
Halal
Food Allergies / Other Requests

Other write-in

Do you have special accessibility needs?

Name*

First Last

Email

Company Name*

Title*

Pronouns*

Pronouns write-in

Write your pronouns here.

Do you have dietary restrictions or needs?

Vegetarian
Vegan
Gluten Free
Kosher
Halal
Food Allergies / Other Requests

Other write-in

Do you have special accessibility needs?

Name*

First Last

Email

Company Name*

Title*

Pronouns*

Pronouns write-in

Write your pronouns here.

Do you have dietary restrictions or needs?

Vegetarian
Vegan
Gluten Free
Kosher
Halal
Food Allergies / Other Requests

Other write-in

Do you have special accessibility needs?

Name*

First Last

Email

Company Name*

Title*

Pronouns*

Pronouns write-in

Write your pronouns here.

Do you have dietary restrictions or needs?

Vegetarian
Vegan
Gluten Free
Kosher
Halal
Food Allergies / Other Requests

Other write-in

Do you have special accessibility needs?

Name*

First Last

Email

Company Name*

Title*

Pronouns*

Pronouns write-in

Write your pronouns here.

Do you have dietary restrictions or needs?

Vegetarian
Vegan
Gluten Free
Kosher
Halal
Food Allergies / Other Requests

Other write-in

Do you have special accessibility needs?

Payment

Would you like an invoice for this instead?

Yes

Discount Code

If you have a discount code you can enter it here.

Total

$0.00

Credit Card*

American Express

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MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name