Fall World 2013 Registration Form
Register By July 22, 2013 for $995. Save $200 in fees!
Date_______________________________List Your CBCP, FBCI, CRP#__________________________________ Registration Rates
Mr/Mrs/Ms______First Name__________________________Last Name _________________________________
Company______________________________________________________Title__________________________
Registration rates for the conference
are as follows:
Cell Phone__________________________________Email ____________________________________________
Address_________________________________________________Mail Stop____________________________
• only $995.00 through July 22, 2013
City__________________________________________State____________________Zip____________________
Country_________________Telephone___________________________Fax______________________________
Print Name As It Should Appear On Badge__________________________________________________________
Make conference checks payable to
Disaster Recovery Journal. All fees
must be paid in US currency only
and payment must be drawn on a
U.S. bank.
List Any Designations For Badge _________________________________________________________________
Three Easy Ways To Register
Emergency Contact Name/Phone Number__________________________________________________________
Fax:
Check here if you require special needs ______ Please specify_________________________________________
636-282-5802
24-hours a day
Mail:
Industry Information
DRJ Registrar
P.O. Box 510110
St. Louis, MO 63151
Indicate Your Industry: ____ Banking/Financial ____ Public Utilities ____Transportation ____Insurance
____ Communications ____ Manufacturing ____ Government ____ Education ____ Computer Services
____ Wholesale ____ Health Care ____ Petroleum ____ Mgmt. Consultant Other:____________________
Web: www.drj.com
For information
Rank Your Experience Level ___ Novice (less than 2 yrs) ___ Intermediate ( 2-5 yrs.) ___ Advanced ( 5+ yrs.)
Is This Your First Conference at DRJ? _____ Yes _____ No
636-282-5800
9 am - 5 pm CST
-or email-
rose@drj.com
Payment Information
Registration Discounts
_____
_____
_____
_____
Cardholders Name_____________________________________________________________________________
Cardholders Billing Address_________________________________________City/State_____________________
Cancellation Policy (Must be in writing): Conference enrollment may be cancelled through Aug. 22, 2013 without
penalty. No refunds or credits will be given for cancellations received after Aug. 22, 2013. All no shows will be charged
the full amount. All cancellations must be received in writing.
I have read and understand the cancellation policy.__________________________________________________
DRJ offers a 10% discount on regis-
tration fees if you meet certain crite-
ria. Review the restrictions below. If
you are eligible, mark the appropri-
ate place on the registration form.
• Three or more employees from the
same company who register at the
same time are eligible for a 10% discount.
• All certified individuals (must be
certified at the time of registration) are eligible for a 10% discount.
• All contingency group members are
eligible for a 10% discount with proof
of membership.
These discounts must be requested
at the time of registration. No refunds
of the discount will be issued, and
only one discount per registrant
will apply.
Check enclosed for $_____________________Which Discounts Apply (if any) ____________________
Bill my company, Attn: __________________________________________________________________
Purchase order attached, P.O. #__________________________________________________________
Bill my ______ Bill my _ ______ Bill my AMEX ______ Bill my DISCOVER
Security Code _______________ (three-digit number found on back of card, four digits on front for AMEX)
Account #___________________________________________________________Exp. Date_________________
Signature____________________________________________________________________________________
