2024 Registration Form - National ERG Leadership Conference

Please indicate how you will attend the conference *In-person ParticipationVirtual Participation

Please select your event(s)

Conference *Conference - $1075.00

ERG CertificationERG Certificate - $525.00

First Name *

Last Name *

Pronouns

Email Address *

Company Name *

Title *

Street Address *

City/State/Zip *

Mobile Phone *0 / 10

Which best describes your ERG involvement? *

Which best describes your ERG affiliation? (please select one) *

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.

If you have food allergies or specialy dietary needs (ex. vegan diet), please indicate here:

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

2024 Comp Code

2024 Comp Con Code

2024 Comp 10 Code

2024 Comp 15 Code

Order Total