2025 Exchange Customer Conference Client Registration

2025 Exchange

Customer Conference Client Registration

If you have questions please contact
Tara Moore at tara@eesagency.com or Kathy Hickerson at kathryn.hickerson@corpay.com.
What you like to do?*

I would like to register for the 2025 Exchange Customer ConferenceI would like to make a change to my registration for the 2025 Exchange Customer ConferenceI would like to cancel my registration for the 2025 Exchange Customer Conference
Full Legal Name*

First NameMiddle NameLast Name
Preferred First Name for Name Badge
Company*
Job Title*
Company Email*
Cell Phone Number*
Please enter a valid phone number.
Office Phone Number
Please enter a valid phone number (if applicable).
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address listed above is:*

HomeOffice
Can we share your contact information with other attendees?*

YesNo
Dietary Restrictions*

NoneLactose IntolerantVeganGluten FreeVegetarianPeanut AllergyShellfish AllergyTree Nut AllergyPescatarianOther
Are you a "first time" attendee to The Exchange?*

YesNo
What are you most interested in learning from this event?
Who is your Sales Representative and/or Relationship Manager?
Pursuant to the American with Disabilities Act, do you require specific aid?*

YesNo
Please detail your ADA needs below:*
Hotel Reservation Information

Please reserve your hotel room at The St. Anthony Hotel - San Antonio, Texas Group Rate $259++ Per Night
Do you need a hotel room?*

YesNo
Please select from the following:

Yes, I have booked my hotel roomYes, but sharing a room with another associate/attendee who is booking the roomNo, but plan to soon
Name of associate/attendee you will be rooming with:
Group Rate $259++ Per Night

Please Click Here To Reserve Your Room

at the St. Anthony Hotel

*The Deadline To Book A Hotel Room

is Friday, February 28, 2025.
Emergency Contact
Name*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Relationship:*
Offsite Events

*Please visit the Events tab of the Navigation Menu for details on the below events and help us plan appropriately. There is limited ticket availability for both options, so please do not delay in selecting an option! Thank You!
**Insert Date Here** | Group Offsite Event*

Yes, I will attend the Client Offsite Event on **INSERT DATE HERE**No, I WILL NOT attend the Client Offsite Event on **INSERT DATE HERE**
Please select your choice **Insert Date Here** | Group Offsite Event*

Event 1Event 2
Please tell us what changes you would like to make to your registration:*
Please tell us why you are canceling your registration:*
Should be Empty:

Customer Conference Client Registration

Hotel Reservation Information

Emergency Contact

Offsite Events