Registration - IMPACT21

Agent Registration

Please complete the information below, then select "Next" to continue.

NOTE: The IMPACT 2021 program is reserved for Electronic Payments sales partners only. Final approval of all registrations and participation are at the discretion of Electronic Payments. The company reserves the right to deny any registrant or non-registrant access to the conference for any or no reason.

Agent Name(Required)

First Last

EPI ISO Office Code(Required)

Email(Required)

Mobile Phone(Required)

Address

Street Address City State Postal/ZIP Code

Gender(Required)

Male

Female

Date of Birth(Required)

MM/DD/YYYY (e.g., 02/12/1970)

Shirt Size(Required)

Special Dietary Preferences

Are you reserving a guest room at the Marriott Harbor Beach Resort & Spa?(Required)

Yes, I do require a guest room and will reserve my accommodations as soon as possible.

No, I have other housing arrangements.

NOTE: Hotel accommodations at the Marriott Harbor Beach Resort & Spa must be made directly through the conference group block. Refer to conference website for instructions on how to reserve a guest room at the discounted group rate.

Guest Registration

To assist in planning for event space, food and beverage obligations, etc., all guests must be registered for IMPACT 2021. If you are bringing a guest, please complete the information below.

Are you bringing a guest to IMPACT 2021?(Required)

Yes

No

Guest Name

First Last

Guest Email(Required)

Guest Mobile Phone(Required)

Guest Gender(Required)

Male

Female

Guest Date of Birth(Required)

Guest Shirt Size(Required)

Guest Special Dietary Preferences

Will your guest participate in the IMPACT 2021 General Session and educational program?(Required)

Yes, my guest will attend all IMPACT 2021 hosted events.

No, my guest will only attend IMPACT 2021 social events.

Will your guest need accommodations at the Marriott Harbor Beach Resort & Spa?(Required)

My guest and I plan to share accommodations.

Yes, my guest will reserve accommodations at the Marriott Harbor Beach Resort & Spa.

No, my guest will not be staying at the Marriott Harbor Beach Resort & Spa.

NOTE: Hotel accommodations at the Marriott Harbor Beach Resort & Spa must be made directly through the conference group block. Refer to conference website for instructions on how to reserve a guest room at the discounted group rate.

Emergency Contact Information

In case of an emergency situation, please provide contact information for someone other than the person traveling with you.

Emergency Contact Name(Required)

This should be someone other than the person traveling with you.

First Last

Emergency Contact Relationship(Required)

Emergency Contact Phone(Required)

Flight/Travel Information

IMPACT 2021 registration includes:

All training and educational sessions
All networking and social events
Access to the POS Lab
Meals (breakfast, lunch, and dinner will be served during each day of the program)
Roundtrip flight (basic airfare on common carriers; see conference website for details)

Attendees are responsible for:

Hotel Accommodations
Ground transport and/or airport transfers
Luggage fees (may differ per airline)
Parking at airport or hotel
Meals (beyond those provided by Electronic Payments)
Incidentals

Will you require a flight to IMPACT 2021?(Required)

Yes, I require a flight.

No, I do not require a flight.

Full Name (exactly as it appears on photo ID)(Required)

NOTE: Electronic Payments will use this information to reserve your preferred flight arrangements. Your full name on the boarding pass MUST match your full name on the photo ID presented to TSA at the airport.

All flights will be reserved for basic airfare on common carriers. Flight preferences are not guaranteed. We will make reservations with preferred travel times and destinations in mind. We will also evaluate considerations such as arrival time, airtime, layovers, etc.

Preferred Local Airport(Required)

Backup Local Airport

Preferred Departure Date(Required)

Preferred Departure Time(Required)

Preferred Return Date(Required)

Preferred Return Time(Required)

Guest Flight/Travel Information

Will your guest require a flight to IMPACT 2021?(Required)

Yes, my guest requires a flight.

No, my guest does not require a flight.

Will your guest's flight arrangement be the same as yours, the primary attendee?(Required)

Yes, my guest will travel with me and requires the same flight itinerary.

No, my guest requires different travel arrangements.

Guest's Full Name (exactly as it appears on photo ID)(Required)

NOTE: Electronic Payments will use this information to reserve your preferred flight arrangements. Your full name on the boarding pass MUST match your full name on the photo ID presented to TSA at the airport.

All flights will be reserved for basic airfare on common carriers. Flight preferences are not guaranteed. We will make reservations with preferred travel times and destinations in mind. We will also evaluate considerations such as arrival time, airtime, layovers, etc.

Guest's Preferred Local Airport(Required)

Guest's Backup Local Airport

Guest's Preferred Departure Date(Required)

Guest's Preferred Departure Time(Required)

Guest's Preferred Return Date(Required)

Guest's Preferred Return Time(Required)

Attendee Cancellation Policy(Required)

If your registration is approved and you can no longer attend IMPACT 2021, you may cancel by providing written notice to marketing@electronicpayments.com. Please understand that reserved airfare is non-refundable. In the event of a no-show, you will be charged for the cost of the airfare.

Please remember that canceling your registration does not automatically cancel your hotel arrangements. Attendees are responsible for canceling their own hotel reservations. You may cancel your hotel reservation without penalty up to 72 hours prior to arrival. If you must cancel after the stated cancellation deadline, the Marriott Harbor Beach Resort & Spa will assess a fee. This fee equals one night of your charges (for the first night of your reservation), plus tax, and will be charged to the credit card on file.

I agree to the cancellation policy.

Conference Photo Release(Required)

Electronic Payments will take photos of attendees throughout the conference. These photos are for Electronic Payments’ use only and may appear on our corporate websites, newsletters, social media platforms, brochures, or other promotional materials.

By virtue of my attendance, I agree to usage of my likeness in such media.

Phone

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

IMPACT 2021 Registration

Agent Registration

Guest Registration

Emergency Contact Information

Flight/Travel Information

Guest Flight/Travel Information

Frequently Asked Questions

Subscribe and get the latest news delivered to your inbox!

Follow Us!