Government Employee Registration

March 21, 2019

Impact AI Summit

Full Name:


Address:


City/State/Zip:


Phone:


Fax:


E-mail:


Company:

You must be be a local/state government employee with a .gov email address. School employees are not considered government employees for the purpose of this rate.

Payment Information

Credit Card payments are required for pre-registration of all NVTC events. If you are unable to pay by credit card and need to pay by check please contact the NVTC's Programs Department at events@nvtc.org.

Charge my


$25.00 (35.00 day of the event)

Card Number:
Exp. Date:
Name on Card:


Additional Information

Will you require special assistance to participate in this event?
No   Yes