Register

Thank you for your interest in the CE Sarasota Symposium! Please stay tuned for information regarding registration for the 2022 event.

Registration
Registration Ticket
Types of Tickets

Attendee price: $450

Silver Exhibitor: $1,500

Gold Exhibitor: $2,000

Founder Exhibitor: $5,000

Leader Exhibitor: $7,000
Select Your Ticket*
Number of Attendees*
Attendee Name*
First Last
Attendee Phone*
Attendee Email*
Attendee Designation*
Attendee Practice Name
Attendee's Primary State License*
Check box if your mailing address & billing address are the same.
- yes
Attendee Address*
This is where the TQ exams will be sent.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attendee #2 Name
First Last
Attendee #2 Phone
Attendee #2 Email
Attendee #2 Designation
Attendee #2 Practice Name
Attendee #2 Primary Licensed State
Attendee #2 Address
Street Address Address Line 2 City State ZIP Code
Attendee #3 Name
First Last
Attendee #3 Phone
Attendee #3 Email
Attendee #3 Designation
Attendee #3 Practice Name
Attendee #3 Primary Licensed State
Attendee #3 Address
Street Address Address Line 2 City State ZIP Code
Attendee #4 Name
First Last
Attendee #4 Phone
Attendee #4 Email
Attendee #4 Designation
Attendee #4 Practice Name
Attendee #4 Primary Licensed State
Attendee #4 Address
Street Address Address Line 2 City State ZIP Code
Attendee #5 Name
First Last
Attendee #5 Phone
Attendee #5 Email
Attendee #5 Designation
Attendee #5 Practice Name
Attendee #5 Primary Licensed State
Attendee #5 Address
Street Address Address Line 2 City State ZIP Code
Billing Information
Coupon
Promotion
Total
$0.00
Billing Email*
What email would you like to receive billing receipt to?
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Register

Registration

Billing Information

Join the mailing list

Additional Information