Step 1 of 4 - Agent Information
Please complete the information below to join the IMPACT 2021 wait list, then select "Next" to continue.
NOTE: The IMPACT 2021 conference is currently full. Submission of this form does not guarantee participation, and Electronic Payments will contact you should any vacancies become available. Please keep in mind that the program is reserved for Electronic Payments sales partners only. The company reserves the right to deny any registrant or non-registrant access to the conference for any or no reason.
In case of an emergency situation, please provide contact information for someone other than the person traveling with you.
If your registration is approved and you can no longer attend IMPACT 2021, you may cancel by providing written notice to email@example.com.
Any hotel reservations made upon registration approval would need to be cancelled by the attendee. Hotel reservations may be cancelled 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.
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.
© 2021 Electronic Payments, Inc.