BEED 2026 Registration Form - Becker Education & Engagement

Phone

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Thank you for your interest in attending the Becker Education and Engagement Day (BEED). BEED will be held at five locations on October 17th and 18th, 2026. Registration and attendance are free for individuals in the Becker community and their families. Please complete the following registration forms. By completing these forms your information will be shared with BEED meeting planners, and you will receive additional information regarding event logistics in advance of the event. Each individual who plans to attend BEED must be registered so we have an accurate headcount. You will have the option to add family members or other members of your party at the end of this form.

If you are an event speaker, please reach out to Elizabeth Bicha elizabeth.bicha@scoutclinical.com for the speaker-specific registration link. You do not need to fill out this form.

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

State of Residence(Required)

What event location are you registering for?(Required)

Please select the option that best represents you(Required)

(Please specify)(Required)

Speakers do not need to complete this form. Please use the speaker-specific registration link, or reach out to Elizabeth Bicha at elizabeth.bicha@scoutclinical.com for the speaker registration link.

T-Shirt Size(Required)

Have you attended BEED in the past?(Required)

Yes

Which BEED events have you attended?(Required)

How did you hear about BEED?(Required)

As part of BEED 2026, will you attend the community dinner on Saturday, October 17 from 6:30pm to 8:00pm?(Required)

Please RSVP so we can plan for an accurate headcount.

Yes

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).

Food Requests

Nut Allergy

Vegetarian

Vegan

Gluten Free

Dairy Free

Kosher or Halal – Please specify below if we need to order a special meal

Celiac

Other - Please specify below

Other Food Requests/Kosher or Halal Meal

Hotel accommodation will be available for attendees traveling to BEED who are in need of lodging. One hotel room, for up to two nights, will be covered per party.

Will you need lodging support for BEED?(Required)

Hotel accommodation will be available for attendees traveling to BEED that are in need of lodging.

One hotel room, for up to two nights, will be covered per party.
If you are traveling with someone, your party is eligible for only one hotel room.

Yes

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. Please note that only one hotel room will be provided per party.

Nights Needed(Required)

Will you or anyone in your party need an accessible room?(Required)

Please note that rooming requests are subject to availability, we will make the best attempt to secure the rooming preference you have selected. Confirmation of your rooming needs will be provided in the coming weeks.

Will you need an accessible room with a roll-in shower?(Required)

Will an accessible room with a tub work for your needs?(Required)

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

How many beds would your party prefer in the hotel room?(Required)

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

Will there be any additional guests to add to this rooming reservation?(Required)

Yes

Please list the first and last name of each additional guest to add to this rooming reservation.(Required)

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

Provide any additional details that will help with your hotel room needs.

Please note that only one hotel room will be provided per party.

Travel Assistance

Your travel assistance request has been approved.

Travel details can no longer be modified through this form. If something needs to change, please contact elizabeth.bicha@scoutclinical.com.

Additional travel assistance beyond hotel accommodations may be requested during registration. Eligible attendees may be approved for reimbursement of certain travel expenses necessary to attend BEED. Travel assistance requests are subject to review and are not guaranteed. Travel assistance is available only for the BEED location closest to an attendee’s primary residence.

Attendees are responsible for making their own travel arrangements and covering expenses upfront. Reimbursement forms and instructions will be provided after the event for approved travel assistance recipients who attend BEED.

If you need lodging assistance, please use the hotel accommodations section above. If you need additional travel assistance, please complete the questions below. If you do not need additional support, please select “No” and continue to the BEED waivers.

Please submit travel assistance requests that cover everyone in your party here. Party members added later will not have a separate travel assistance request section.

Are you in need of travel assistance?(Required)

Yes

What type of travel assistance are you requesting?(Required)

Flight reimbursement

Mileage reimbursement

Train reimbursement

Other travel assistance

Flight Reimbursement. For those requesting assistance with flights, you can receive a reimbursement of up to $300 per airline ticket to travel to the BEED event nearest to you. Attendees are responsible for making their own travel arrangements and covering expenses upfront. Reimbursement forms and instructions will be provided at the conclusion of the event for approved recipients who attend BEED.

How many airline tickets are you requesting reimbursement for?(Required)

Typical reimbursement is limited to up to two tickets per party. You have requested more than two tickets, so your request will require additional review by the BEED planning team. Please explain why additional tickets are needed.

Please provide additional reasoning for more than 2 tickets(Required)

Who are the tickets for? Please list the first and last name of each traveler.(Required)

Departure city/state

Total estimated airfare for all requested tickets(Required)

Mileage Reimbursement. For those requesting mileage reimbursement, reimbursement is available up to a maximum of $150 total at the applicable IRS standard mileage rate. Mileage will be calculated from your home address to your nearest BEED event location through the reimbursement form. Attendees are responsible for covering expenses upfront; reimbursement is provided after the event for approved recipients who attend BEED.

Estimated round-trip mileage(Required)

Train Reimbursement. For those requesting train reimbursement, reimbursement is available up to $150 per ticket for travel to the BEED event nearest to you. Attendees are responsible for covering expenses upfront; reimbursement is provided after the event for approved recipients who attend BEED.

How many train tickets are you requesting?(Required)

Please enter a number greater than or equal to 1.

Please explain why more than two tickets are needed.(Required)

Estimated fare per ticket(Required)

Other Travel Assistance. Attendees are responsible for making their own travel arrangements and covering expenses upfront. Reimbursement is provided after the event for approved recipients who attend BEED.

Please indicate any additional travel assistance you would need to make attending BEED possible.

These requests will be reviewed by the BEED planning team, and someone will follow up within 10 business days.

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.

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.

Photo Consent e-Signature First and Last Name(Required)

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.

Add Your Party Members

Each individual who plans to attend must be registered. You can add the other members of your party below. Please note that hotel and travel assistance requests for your entire party are submitted here, in the primary registrant's form above. Additional party members you add will not have separate hotel or travel assistance request fields.

How many people are in your party?(Required)

Please add the information for each member of your party using the section below. You do not need to complete this entire registration form again for them. Just enter each party member's details in the popup below.

Please enter your party members' information.

It is important that every member of your party is included here so we have an accurate headcount and required waiver/consent information for each attendee. The information you put here helps us keep track and make sure that everyone that needs to register has done so.

Name	Email	Phone	Relationship to Becker	Please specify	T-Shirt Size	Food Requests	Other Food Requests/Kosher or Halal Meal	Liability Waiver e-Signature: First and Last Name	Photo Consent e-Signature First and Last Name	Actions

There are no Party Members.

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What is your primary language?

El BEED se llevará a cabo en Orlando, Florida y todos los miembros de la comunidad están invitados a acudir. Este año habrá un intérprete/traductor disponible en esta ubicación para aquellas personas que hablan español, para que participen y tengan acceso a esta información. Por favor, tome en cuenta que el evento será en inglés pero el intérprete estará disponible en todas las sesiones en sábado. No habrá traducción disponible para el recepción por la tarde el viernes 26 de septiembre. El sábado 27 de septiembre será un día completo de conferencias donde habrán traducciones disponibles a lo largo del día.

Will you require translation services in Spanish?(Required)

Yes