Test Event and Developers Forum Observer Registration June 4-6, 2018 Jorte, Tokyo, Japan Please use this form to register to observe the upcoming CalConnect Interoperability Test Event and Developers Forum. You have a choice of payment options including check or electronic funds transfer, requesting that the Consortium send you an Invoice for payment, or payment by Paypal or credit card. You may be observers at the Test Event whether your organization is a member of the Consortium or not. As observers you may not actually test code but you may participate in the discussions. Please be aware that your organization may only attend one Test Event as an observer. If you wish to register to participate in the associated Conference as well, please see Conference Registration. Please review Getting Started. Although you will be observing rather than participating in the test event, this should give you a reasonable amount of familiarity in advance of the event itself. Company or Organization * Primary Contact for Observers Name * E-Mail Address * Telephone Dietary Restrictions? Additional Observers Additional Participant 1 Name E-Mail Address Dietary Restrictions? Additional Participant 2 Name E-Mail Address Dietary Restrictions? Additional Participant 3 Name E-Mail Address Dietary Restrictions? Additional Participant 4 Name E-Mail Address Dietary Restrictions? Additional Participant 5 Name E-Mail Address Dietary Restrictions? IOP Test Event Observer Fee The fee to observe a CalConnect Interoperability Test Event is $450 per person whether your organization is a Consortium member or not. Your organization may only attend one test event as an observer. If you wish to participate in the follow-on Conference as well and you are a representative of a Consortium member or elect to attend the Conference as Observers, please register separately for the Conference; see Registration and Payment Options. We regret that we are unable to process both CalConnect Interoperability Test Event and Conference registrations on the same form; however, you may request a combined Invoice for a single payment. Please enter the total amount for your registration * How do you plan to pay? In all cases you will receive an invoice after registration and a paid invoice once your payment has been received and processed. Payment Type * We will pay by check or money order (must be issued by a U.S. bank) We will pay by ACH (electronic funds transfer) (please contact us for transfer details) We will pay via Paypal (send your payment to: dave.thewlis@calconnect.org) We will pay via credit card (Visa, Mastercard, American Express) and will call or fax credit card details in the near future We will pay via credit card (Visa, Mastercard, American Express) and wish to pay at the event Purchase Order If you have a Purchase Order and wish your Purchase Order Number shown on your invoice please enter it here. If you are also registering for the Conference and wish to receive a single Invoice or execute a single payment transaction covering both this Test Event registration and the Conference registration, please contact us as indicated in the response you will receive to this submission. CalConnect Interoperability Test Event Confidentiality Agreement By completing this Event Registration form and paying the appropriate registration fee, your organization agrees to the CalConnect Interoperability Test Event Confidentiality Agreement. As observers, you also agree to comply with the Conduct for Observers at CalConnect Interoperability Test Events. I agree for myself, my organization, and for any other individuals (named above) for whom I am acting in submitting this registration, that we have reviewed and will comply and be bound by the CalConnect Interoperability Test Event Confidentiality Agreement. Yes No I will abide by the CalConnect Interoperability Event Confidentiality Agreement * Before Submitting: Please review your completed participation form carefully. Once you have pressed the "SEND" button below, you will be given further information for completing the credit card transaction. Leave this field blank What code is in the image? * Send
