2023 Group Registration Form - National ERG Leadership Conference

Group Members

Company Name *

Mobile Phone *

LinkedIn Address *

Which best describes your ERG involvement? *

Name *

Email Address *

Title

Pronouns

Please indicate how you will attend the conference *In person participationVirtual participation

Please select your event(s)

Conference *Conference - $454.5010% group discount included

ERG Workshops10% group discount included

ERG Certificate (in person only)ERG Certificate (in person only) - $400.00

Some breakout discussions will consist of people in same/similar groups. Please rank the groups below in which you’d like to engage with in discussion.

Discussion Group (1st in Importance) *

Discussion Group (2nd in Importance) *

Discussion Group (3rd in Importance) *

Please list any dietary restrictions or food allergies.

If you have a disability and may require accommodations in order to fully participate, please indicate here.

If you need special accommodations, please indicate here how you would like to be contacted to discuss your needs.

Event Total

Discount CodeIf you have a discount code, please enter it here to apply to your total.

Sponsor Code Discount

Champion Code Discount

Advocate Code Discount

Ally Code Discount

Partner Code Discount

Conference300 Discount

Conference250 Discount

Guest Code Discount

Manual Discount

Order Total