DINNER & CEO SUMMIT

REGISTRATION

October 16 and 17, 2023 | Rainbow Room, NYC

Important information:
NYC regulations require proof of vaccination for COVID-19 and identification for all attendees.

    Will you be attending *:

    First Name*

    Last Name*

    Company Title*

    Company*

    Primary E-mail*

    Secondary E-mail

    Primary Phone Number *

    Secondary Phone Number

    Do you have an executive assistant?*

    Executive Assistant First Name*

    Executive Assistant Last Name*

    Executive Assistant Email*

    Executive Assistant Telephone*

    Do you have an executive Second assistant?*

    2nd Executive Assistant First Name*

    2nd Executive Assistant Last Name*

    2nd Executive Assistant Email*

    2nd Executive Assistant Telephone

    Are you a University of Pennsylvania Alumnus?*

    Alumni Designation (e.g. WG68 or C99)*

    * Required Fields