2023 Partnership Collaboration Summit Registration Form

February 22-24, 2023

Name: Member #:

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REGISTRATION RATES - TASN Members Only

$475

Registration: Deadline date is January 31, 2023: (Must be post marked by January 31, 2023 to receive regular registration rate). All attendees complete and sign a registration form.

REGISTRATION TOTAL

All cancellations must be received in writing no later than January 31, 2023. There will be a $50.00 administrative fee on all cancellations. No refunds will be made after January 31, 2023.

Please check this box if you have allergies or special requirements. If you checked the box, please explain further:

PAYMENT OPTIONS

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LIABILITY & INDEMNIFICATION AGREEMENT

Please Initial

LIABILITY & INDEMNIFICATION AGREEMENT: I request that you accept me as a participant at the TASN Partnership Collaboration Summit to be held in Arlington, TX at the Live! by Loews from February 22-24, 2023. I understand there are some risk inherent in traveling to and from and as a result of attending the summit. The undersigned hereby releases TASN, the Initial committees, members, officers, employees and directors from all liability for injury, death, and property damage. Company/Attendee agree that they will not engage in in-person activities with TASN employees or summit attendees if the attendee has: a fever, Covid-19 symptoms, recently been diagnosed with Covid-19, or has experienced or been in contact with person/s who have tested positive for Covid-19 or has symptoms. TASN and the Live! by Loews reserves the right to ask you to leave the event if you do not adhere to social distancing guidelines and mask requirements, and/or if you are experiencing covid-19 symptoms.

Please Initial

PHOTO RELEASE: I grant TASN, its representatives and employees the right to take photographs of me and my property. I authorize TASN to copyright, use and publish the same in print and/or electronically. I agree that Initial TASN may use such photographs of me with or without my name and for any lawful purpose, including such purposes of publicity, illustration, advertising, social media networking and web content.