Test Event and Developers Forum Participant Registration

Please use this form to register to participate in the upcoming 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 credit card or Paypal. If you wish to register to participate in the associated Conference as well, please see Conference Registration.

You may participate in the test event whether your organization is a member of the Consortium or not. Non-members pay a surchange on their registration fee.

If this will be your first Test Event, please review Getting Started.

Members of the Consortium may participate in a Test Event remotely if they are unable to come to the event and have participated on-site in at least one previous Test Event. Please check the "Remote Participation" box below. PLease be aware that this option is not always possible due to local conditions and participants.

Company or Organization *

Primary Contact for Participation

Name *

E-Mail Address *

Telephone

Dietary Restrictions?

Additional Participants

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?

What Do You Want To Test

Please tell us what your testing interests are for this event (you may see the currently planned testing scenarios at Next Interoperability Test Event). If you want to test anything not listed, be sure and tell us! We will be happy to include it so long as at least two participants are interested.

Testing Interests

We have periodic conference calls to organize and plan for each test event. Please contact Dave Thewlis for information about joining these calls.

What Topics Would You Like to Discuss During the Developer Forum Discussions

Please tell us of any particular discussion topics you’d like added to the list of topics for the upcoming discussions during the Developers Forum portion of the Test Event? These discussions generally happen at a mutually agreeable time for all interested participants during the 2.5 day test event. (You can see the existing list of discussion topics under the Test Event section of the event web page.)

Topics for Discussion

Remote Participation

Members of the Consortium may participate in the Interoperability Test Event remotely if they are unable to be present. The individual(s) testing remotely must have participated in person in at least one Interoperabilty Test Event in the past. At this time CalConnect does not charge for remote participation, but reserves the right to do so in the future.

Participate remotely

We wish to participate in this event remotely as we are unable to attend the event in person. We have participated in at least one Interoperabilty Test Event in the past.

We do not wish to participate remotely.

Interoperability Test Event Participation Fees

The fee for the first two participants for the CalConnect Interoperability Test Event for all vendor and organizational members is $1,000 per person. Additional participants are $250 per person.

The fee for Individual members is $450 per person.

There is no fee for the first two participants from the host member of the event; additional participants are $250 per person.

Non-members will be charged as above, but assessed a 25% surcharge.

There is currently no fee for participating remotely. If you are participating remotely please enter $0 as the fee amount and check the remote participation button under payment method. You will not be charged or receive an invoice.

Remember, remote participation is available only to CalConnect members who have previously attended at least one Test Event in person.

Please see Interoperability Test Event Participation Fees for more information.

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 wish 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

We are only participating remotely; no fee is required at this time

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 Roundtable 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.

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

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.

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