VIP Delegate signup

Package Includes:

* Executive Platforms reserves the right to refuse any registrations that are not deemed to be end users to the supply chain industry

$2,995

Company Details

Company name *

Address *

Zip/Postal Code *

State/Province *

City *

Country *

Attendee Details

Title

Mr.

Ms.

Miss.

Mrs.

Dr.

First name *

Last name *

Phone *

Mobile

Email address *

This also serves as your username when logging in to manage your account

Job title *

Twitter handle @

Additional attendees

Title

Mr.

Ms.

Miss.

Mrs.

Dr.

First name *

Last name *

Phone *

Mobile

Email *

Job title *

Twitter handle

@

Administrative contact (optional)

Name

Phone

Email

Executive Platforms Inc.
56 The Esplanade Suite 408
Toronto, On
M5E 1A7

T: 416-829-6500
F: 647-350-1495