2025 AFC VIP+ | Final Registration Step2025 A.G.E.S. Fall Conference | VIP+ Final Registration StepPlease fill in the form below so that our team can provide you with the best experience at the conference. Please use the email you used to purchase/register.Personal InformationFirst NameLast NameBadge Name (as you want it to appear on your badge, if different from above)Email AddressOn-Site Emergency Contact NamePhone/MobileOn-Site Emergency Contact PhoneFood & AllergiesThe questions below pertain to food & allergies.Please select your choice of entree for the Friday night awards dinner.ChickenVegetarianFood allergies - Please let us know if you have any food or beverage allergies. We will do our best to accommodate you. All buffet items will be labeled for reported allergies, but we cannot guarantee a 100% allergy-free environment.Gluten FreeNutsShellfishDairyWheatOtherIf you selected other above, please explain.Additional InformationADA - Special Needs - Please Describe A.G.E.S. will do our best to accomodate, but we make no guarantees that we will be able to meet all needs.- Select -MobilityVisualAuditory - note: we do not close-caption and do not have sign interpreters on site.OtherNone of the aboveIf you selected other above, please explain. I have read and agree to the Marketing and Event consent for in-person and online events. You can review our policy here. Are you human?Submit Form
