Name*

First Name

Last Name

Company*

Title*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

I am using*

Home Address Business Address

Day phone*

Fax

Email*

Is your company sponsoring you to attend?*

Yes No

How many years have you been with your current employer?*

Less than 1 1-3 4-6 7-9 10+

What career level best descibes you?*

Entry level Vice President Mid-level Manager General Manager Sr-level Manager C-Suite Director President

Host Hotel*

Disney Yacht & Beach Club Resort

Other:

Have you attended this event in the past?*

11 12 13 14 15 16 17 First Time

Which topics are you most interested in learning about?*

Leadership and Management Work/Life Balance Career Advancement Lifestyle Corporate Trends

Salary Range*

How did you hear about the Women of Power Summit?*

REGISTRATION

Registration Fees (per person)*

Sponsor Registration Rate - $895

Credit Card*

Card Verification Code*

Expiration Date*

Signature*

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Method of Payment

Full payment is required with completed registration form. Please note, there is a $100 non-refundable processing fee for all cancellations. Make checks or money order payable to Graves Ventures, L.L.C./dba. No checks will be collected onsite.

Mail to:

Black Enterprise Women of Power Summit

260 Madison Avenue, 11th floor

New York, NY 10016

Refund/Cancellation Policy

A refund of all registration fees minus a $100 processing fee will made upon receipt of written cancellation postmarked no later than January 13, 2018. No subsequent refunds will be made after January 13, 2018. Participants may transfer packages until March 1, 2018. All requests must be submitted in writing to B.E. Women of Power Summit , 260 Madison Avenue, 11th floor, New York, NY 10016 or Fax at 212-886-9509

Please Note: It will be mandatory for all participants to sign an event waiver and wear an

I.D. badge to participate in the event. We may use your e-mail address for future solicitation.

By registering for this event, you agree to receive follow-up communication from BLACK ENTERPRISE and its partners, if you wish to opt out of these mailings, please check:

OPT OUT