Kidscreen Summit 2019 Registration Form

Step 1/6

If you have a promo code, please enter it here:

Just Kidscreen Summit	US$1995
Kidscreen Summit + One Master/Mentor Class ($1995 + $250)	US$2245
Kidscreen Summit + Two Master/Mentor Class ($1995 + $500)	US$2495

For group rates, please contact Joel Pinto at 416-408-2300 x650 or jpinto@brunico.com.

Step 3/6

Delegate Information

Fields marked with red asterisks (*) are required. Read the fine print for cancellation and substitution policies.

Salutation

First Name

* Required

Last Name

* Required

Title

* Required

Job Function

* Required

Job Function (Other)

* Required

Company

* Required

Parent Company

Primary Business

Company Size

Address

* Required

Address 2

City

* Required

Country

* Required

State/Province

* Required

Zip/Postal Code

* Required

Company Phone

* Required

Direct Phone

* Required

Company Fax

Direct Fax

Email Address

* Invalid Email Address

Please verify the email address

* Does not match

Website

This form is being completed by the attendee indicated above

Yes No

Please indicate how you learned about this event

* Required

Please specify:

* Required

Your Delegate Badge Information

Name on Badge

Company on Badge

Company Website on Badge

Twitter Username

Step 4/6

Credit Card Details

Fields marked with red asterisks (*) are required. Read the fine print for cancellation and substitution policies.

Method of Payment

Visa
MasterCard
American Express
* Required

Card Number

* Required

Expiry Date

*Required *Required

Cardholder Name

* Required

If the name on credit card is someone else, then what is your relationship to this person?

Billing Contact

* Required

Billing Contact Email

* Required

Billing Company

* Required

Billing Address

* Required

Billing Address 2

Billing City

* Required

Billing Country

* Required

Billing State/Prov

* Required

Billing Zip/Postal Code

* Required

Step 5/6

Complete Order

Your credit card will be charged once you click on the 'Complete Order' button below. The charge on your credit card will appear as Brunico Marketing Inc.

Upon clicking 'Complete Order' please do not refresh your browser or click the back button. Please wait for the process to finish. Failure to do so may result in duplicate charges to your credit card.

Step 6/6

Order submitted, please wait.

Please do not refresh your browser or click the Back button as this may result in duplicate charges on your credit card.

Cancellation Policy: Should you be unable to attend this event, we require notice in writing (customersupport@kidscreensummit.com) on or before January 11, 2019 at 5:00pm, ET. Cancellations made after this date will not be eligible for a refund. All cancellations are subject to an administration fee equal to 50% of the invoiced purchase price. All prices are quoted in US$. Your registration may be transferred to another individual at no charge. Should you wish to transfer your registration to another person, please inform us by email to customersupport@kidscreensummit.com, a minimum of 48 hours prior to the event. The following details will be required: (*Mandatory) *Name of Attendee taking your spot, *Title of Attendee, Direct Phone and Fax Number, *Email Address, and *Company Details (*Name, *Address, Website and *Phone and Fax Numbers). If for any reason whatsoever the conference is cancelled, the liability of Brunico Marketing Inc. shall be limited to reimbursement of the conference fees. Producer reserves the right, with reasonable notice, to change program dates and venues and assumes no liability for the changes. NOTE: Registration fees must be paid in full in order to gain entry to the event. No exceptions will be made.

Information collected through this web form is subject to our privacy policy and is collected for the following express purposes:

To fulfill your registration request
To accurately obtain your information
To contact you regarding your registration: to verify the information supplied by you; to allow you to make changes to your information; to confirm your registration; to issue a payment receipt; to issue an invoice; to solicit your feedback regarding the event; to inform you of changes to the schedule or new developments related to the event. Contact may be made via email, mail, fax or telephone.
To include your information on the event's published delegate list