CBES Registration - Vantage Point

Registration Type*

Co-op Information

Cooperative*

Name of Broadband operation, if applicable

Address*

Street Address Address Line 2 City State ZIP Code

Broadband Status*

Which BEST describes your current deployment status?

Still Planning/Exploring
Deploying, no customers yet
Early operational
Operational 2+ years

Association Information

Thank you for your interest in attending the Co-op Broadband Executive Summit! We are pleased to offer your association one complimentary registration; guests and additional representatives may join for an additional registration fee.

Association

Website

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attendee Information

Name*

First Last

Preferred shirt/jacket size (attendee)*

Email*

Please enter the email address for the ATTENDEE. If another person should receive information as well (ie, Executive Assistant) please enter that email in the "Secondary Email" line below.

Phone*

Position/Job Title*

Secondary Email

If another person (ie, Executive Assistant) should receive information about this event, please enter their email here.

Networking Guide*

To facilitate networking among Cooperatives, an attendee list will be provided to Summit participants. In addition to your name and Co-op, do you consent to have your contact information and broadband status included in this networking guide?

Yes, include my information
No

Networking Event*

We invite you to join us for an off-site networking event on Tuesday afternoon. Guests are welcome to participate. This excursion is included in your registration; there is no additional fee.

Yes, I'll participate on Tuesday
No, I decline.

Guest Registration

Guests are welcome at breakfast, receptions, and networking events.

Guest Name

First Last

Preferred shirt/jacket size (guest)

Add an additional attendee?*

Additional Attendee

Name - Second Attendee

First Last

Preferred shirt/jacket size (second attendee)

Email - Second Attendee

Phone - Second Attendee

Position/Job Title - Second Attendee

Secondary Email - Second Attendee

If another person (ie, Executive Assistant) should receive information about this event, please enter their email here.

Networking Guide - Second Attendee

To facilitate networking among Cooperatives, an attendee list will be provided to Summit participants. In addition to your name and Co-op, do you consent to have your contact information included in this networking guide?

Yes, include my information
No

Networking Event - second attendee

We invite you to join us for an off-site networking event on Tuesday afternoon. Guests are welcome to participate. This excursions is included in your registration; there is no additional fee.

Yes, I'll participate on Tuesday
No, I decline.

Guest Registration - Second Attendee

Guests are welcome at breakfast, receptions, and networking events.

Guest Name - Second Attendee

First Last

Preferred shirt/jacket size (second attendee guest)

Let's make this a GREAT event

Agenda Requests

Questions to ask, research to share, or stories to tell - If there are any areas you want to make sure we cover at the Summit, let us know!

Food Sensitivity*

Any food sensitivities or allergens we should know about for attendees or guests?

Finish & Payment

Special Access Code

If you were given a special access code, please enter it here.

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

July 14-16 in Buffalo, New York

Co-op Information

Association Information

Attendee Information

Additional Attendee

Let's make this a GREAT event

Finish & Payment