Thank You For Registering As A VIP!

One More Step To Complete Your Registration!

Annual Fall Conference Form Completion Required

To complete your registration to our Annual Fall Conference – Make Yourself Healthy Again, complete the form below.

Once the form is submitted, you will be taken to you our Thank you page. If you are new to My EHI Aloha, please follow the instructions on our Thank you page to reset your password.

A.G.E.S, Make Yourself Healthy Again Happy Mother Daughter Father Outdoors

2025 AFC VIP | Final Registration Step

2025 A.G.E.S. Fall Conference | VIP Final Registration Step

Please 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 Information

First Name

Last Name

Badge Name (as you want it to appear on your badge, if different from above)

EMAIL ADDRESS

Phone/Mobile

On-Site Emergency Contact Name

On-Site Emergency Contact Phone

Food & Allergies

The questions below pertain to food & allergies.

Food 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.

If you selected other above, please explain.

Additional Information

ADA - 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.