KSI InTouch Conference

Registration Form

Personal / Business Information Please enter your contact information below (All items must be completed)

Would you be interested in attending an Optional Technology Training Session on Wednesday morning? *
Would your guest be interested in attending an Optional Technology Training Session on Wednesday morning? *

Spouse / Guest Information:

Hotel Information

*KSI will be making the hotel reservations for you. Our group room rate is only valid 3 days before and 3 days after our event. If you are planning an extended stay, a room is not guaranteed.

**Please note- If you are unable to attend, please email Mindy Marble at mindy@kovacksecurities.com no later than September 25th. If you do not attend and do not cancel with Mindy, the cost of one night's stay, ($229 plus tax), will be charged against your commissions.

Please check the box to confirm your understanding: *
Will You Need Hotel Room *

Credit Card Information

Credit card information is required for all reservations
unless KSI is paying for the entire stay.
 
Please provide credit card information using the secured credit card form below:
Credit Type

Meal Information - Wednesday, 10/02

Attending the Continental Breakfast *
Will a guest be joining you for the Continental Breakfast *
Attending the Buffet Luncheon *
Will a guest be joining you for the Buffet Luncheon *
Attending the Evening Reception *
Guest attending the Evening Reception *

Thursday, 10/03

Attending the Breakfast Buffet *
Will a guest be joining you for the Breakfast Buffet *
Attending the Buffet Luncheon *
Will a guest be joining you for the Buffet Luncheon *
Attending the Evening Reception *
Will a guest be joining you for the Evening Reception *
Attending the Dinner * 
Bringing guest to Dinner *
* Please Note-because of the high cost of this event, if you register for the dinner and do not attend, the cost for food and drinks of $175 per person will be charged against your commissions.
Please check the box to confirm your understanding: *

Friday, 10/04

Attending the Breakfast Buffet *
Will a guest be joining you for the Breakfast Buffet *