Attendee Registration – Becker Education & Engagement

What event location are you registering for?

Please select the option that best represents you

(Please specify)(Required)

If you are an event speaker, please reach out to Elizabeth Bicha elizabeth.bicha@scoutclinical.com for the speaker registration form link.

Please register for each person attending.

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

State of Residence(Required)

How did you hear about BEED?(Required)

Refreshments and food will be provided during the event, please provide any dietary restrictions we should be aware of and we will try our best to accommodate (specific food requests are not guaranteed).

Other Food Requests/Kosher or Halal Meal(Required)

T-Shirt Size(Required)

Hotel accommodation will be available for attendees traveling to BEED that are in need of lodging. One room, for up to two nights, will be covered for attendees. Will you need lodging support for BEED? (If you are traveling with someone, please only have one registrant fill out the hotel request form).

Hotel Request(Required)

Hotel Accommodation

Hotel lodging will be booked for individuals based on availability and the needs of attendees. Please fill out the information below and the BEED meeting team will reach out for any additional information and to confirm your reservation at the hotel.

Nights Needed

Will you need an accessible room?(Required)

Will you need a bed that a patient lift can roll under?(Required)

Will you need one bed or two beds in your room?(Required)

Provide the first and last name for the hotel reservation(Required)

Please provide any additional guests' first and last names(Required)

Provide a phone number to be contacted for any questions regarding this reservation(Required)

Travel Assistance

If you are in need of lodging assistance, please fill out the form above. If you are in need of additional travel assistance to attend BEED please fill out the following form. If you do not need additional support, no response is needed within this section, please move on to the waivers for BEED.

Travel assistance is available on a case-by-case basis and upon availability. If you will be unable to attend BEED without travel assistance, please fill out the following form to tell us more about your travel needs. Parking at the event will be covered.

Where are you traveling from to attend BEED?

What additional assistance would you need to be able to attend the event?

Liability Waiver

By attending the Becker Education and Engagement Day (BEED) event, attendees acknowledge and agree to the following terms and conditions:

Assumption of Risk: Attendees understand and acknowledge that their participation in the BEED event is voluntary and involves inherent risks, including but not limited to physical injury, property damage, or other potential hazards. Attendees assume full responsibility for any risks of injury, loss, or damage arising from their participation in the event.
Release of Liability: Attendees hereby release, waive, and discharge Becker Education and Engagement Day, its organizers, sponsors, volunteers, and affiliated entities from any and all claims, demands, liabilities, or causes of action, whether known or unknown, arising out of or related to any injury, loss, or damage incurred during or as a result of attending the BEED event.
Indemnification: Attendees agree to indemnify and hold harmless Becker Education and Engagement Day, its organizers, sponsors, volunteers, and affiliated entities from any claims, liabilities, damages, or expenses (including attorney's fees) arising from their participation in the event or any actions, omissions, or negligence of the attendee.

By attending the Becker Education and Engagement Day event, attendees acknowledge that they have read, understood, and agreed to the terms of this liability waiver.

e-Signature First and Last Name(Required)

by e-signing you agree to all the Terms and Conditions.

Photo Consent

Please be advised that photographs will be taken at these events, and by attending, you grant BEED the right to use your photograph(s) in any manner or media, including, but not limited to, the promotional materials and websites.

Please be advised that photographs will be taken at these events, and by attending, you grant BEED the absolute right and permission to use your photograph(s) in any manner or media, including, but not limited to, the following purposes:

Educational materials
Publications
Advertising and promotional materials
Social media platforms
Websites
Press releases

Please contact Elizabeth Bicha elizabeth.bicha@scoutclinical.com if you have any questions or concerns.

Photo Consent e-Signature First and Last Name

By e-signing, you agree to the use of your photograph(s) in any manner or media, including promotional materials and websites, as outlined above.

Please contact Elizabeth Bicha elizabeth.bicha@scoutclinical.com if you have any questions or concerns.

How many people are in your party?(Required)

Please enter a number greater than or equal to 1.

You must submit a registration form for each member of your party!

Email

This field is for validation purposes and should be left unchanged.