Register

First Name: *

Last Name: *

Preferred First Name on Badge: *

Company Name: *

Work Email: (Please use correct email or form will not process correctly) *

Preferred email for the conference app (you must have access to this email onsite):

Street: *

City: *

State: *

Zip Code:

Work Phone:

Cell Phone: *

Fax Number:

Emergency Contact Name: *

Emergency Contact Phone Number: *

Shirt Size (unisex): *

Benefit Level: *

How many guests will you be bringing: *

Please list their full names:

*Kovack will be making the hotel reservations for you. Our group room rate is only valid 3 days before and 3 days after our event. If you are planning an extended stay, a room is not guaranteed.

**Please note- If you are unable to attend, please email Mindy Marble at mmarble@kfn.com no later than September 26th. If you do not attend and do not cancel with Mindy, the cost of one night's stay, ($309 plus tax), will be charged against your commissions.

Will You Need A Hotel Room? *

YesNo

Hotel Arrival Date: *

Hotel Departure Date: *

Room Type *

Special Needs:

Marriott Rewards Number:

Credit card information is required for all reservations unless Kovack is paying for the entire stay.

Please provide credit card information using the secured credit card form below:

Credit Type:
American ExpressMasterCardVisa

Conference Attendee's Name:

Card Holder Name, (as shown on card):

Card Number:

Expiration Date (mm/yy):

ID Number: 🛈

Telephone Number:

Street Address:

City:

State:

Zip Code

Monday, October 14th

Attending the Continental Breakfast: *

YesNo

Will a guest be joining you for the Continental Breakfast:

YesNo

Attending the Buffet Luncheon: *

YesNo

Will a guest be joining you for the Buffet Luncheon: *

YesNo

Attending the Evening Reception: *

YesNo

Guest attending the Evening Reception: *

YesNo

Tuesday, October 15th

Attending the Breakfast Buffet: *

YesNo

Will a guest be joining you for the Breakfast Buffet: *

YesNo

Attending the Buffet Luncheon:*

YesNo

Will a guest be joining you for the Buffet Luncheon:*

YesNo

Attending the Evening Reception: *

YesNo

Will a guest be joining you for the Evening Reception: *

YesNo

Attending the Dinner: *

YesNo

Bringing guest to Dinner: *

YesNo

* Please Note-because of the high cost of this event, if you register for the dinner and do not attend, the cost for food and drinks of $225 per person will be charged against your commissions.

Please check the box to confirm your understanding:
Yes, I understand.

Wednesday October 16th

Attending the Breakfast Buffet: *

YesNo

Will a guest be joining you for the Breakfast Buffet:

YesNo

The deadline to register is August 23rd

Monday, October 14th

Tuesday, October 15th

Wednesday October 16th

2023 Kovack InTouch National Conference

2023 Virtual Administrative Professional Conference "Administrative Assistants...the lifeline to every office"