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Group Discount:
3 or more attendees: 20% discount
Discount is taken from current pricing for the
ENGAGE311 Conference and is not
combinable with other discounts or other CS
Week venues.
______________________________________________________________________________________________________
ENGAGE311 Group Registration Form
Complete this registration form if you would like to register 3 or
more individuals from your company to attend the 2018 ENGAGE311
Conference in Tampa, Florida.
IMPORTANT NOTE: Attendee registration for this
package is available for utility employees only and all
forms must be submitted from the same Company at
the same time to receive the discount.
______________________________________________________________________________________________________
How to Register
All group discount registrations must be submitted from the same company at the same time.
STEP 1: Complete Coordinator Contact Information
STEP 2: Complete Method of Payment section
STEP 3: Complete Contact Center Profile section
STEP 4: Fill out individual information for each registrant in group. Please also indicate if any individuals will be attending
CS Week Conference 42 on Thursday and Friday for a discounted rate of $550. (The 20% discount does not apply to the CS
Week Conference rate, it only applies to the ENGAGE311 Conference rate)
STEP 5: E‐mail or print out and fax or mail the forms:
Email: [email protected]
Fax: 903‐893‐6136
Mail: CS Week
Attn: Amber Wiens
2612 W Lamberth Rd Ste 300
Sherman, TX 75092
______________________________________________________________
Group Coordinator Contact Information
Name:
Company Name:
Mailing Address:
City: State/Providence:
Postal Code: Country:
Email:
______________________________________________________________
Method of Payment
Payment by check (must be US Funds), or credit card must accompany your registration in order to be processed and receive
your confirmation. Please note: you are not registered until you receive an email confirmation from CS Week. The tax ID
number is 75‐2609026.
Check Enclosed # (Make check payable to: CS Week)
Charge my Credit Card (we accept VISA, MC, DISCOVER and AMEX)
Card Number: Expiration Date:
Security Code: Name on Card:
Signature:
**By checking one of the boxes above, I understand that my group will be unable to attend the conference until
registration is paid in FULL.
BILLING ADDRESS
Name: Phone Number:
Address:
City: State:
Postal Code: Country:
______________________________________________________________
Contact Center Profile
Contact Center website:
Types of Calls received in your contact center (select all that apply):
☐ Animal Control ☐ Birth Certificates ☐ Business Licenses ☐ Code Compliance ☐ Consumer Health
☐ Credit & Collections ☐ Dispatch ☐ DMV ☐ Environmental Mgt ☐ Finance ☐ Municipal Court ☐ Parking
☐ Parks & Rec ☐ Planning & Development ☐ Police (non‐emergency) ☐ Public Works ☐ Social Services
☐ Solid Waste/Sanitation ☐ Storm Water ☐ Streets ☐ Taxes ☐ Transportation ☐ UtilitiesOther (Please list):
What is your City’s population?
☐ 50,000 or less ☐ 50,001 – 250,000 ☐ 250,001 – 500,000 ☐ 500,001 – 999,999 ☐ 1 million or more
Annual Calls Handled in your contact center?
☐ 100,000 or less ☐ 100,001 – 300,000 ☐ 300,001 – 500,000 ☐ 500,001 – 999,999 ☐ 1 million or more
Social Media your call center utilizes:
☐ Facebook ☐ Instagram ☐ Mobile App ☐ Twitter ☐ YouTube ☐ LinkedInOther (Please list):
How many years has your City had 311?
☐ 1 year or less ☐ 2‐4 years ☐ 5‐6 years ☐ 7‐8 years ☐ 9‐10 years ☐ More than 10 years ☐ Considering 311
How many agents are employed at your call center?
☐ 20 or less ☐ 21‐40 ☐ 41‐60 ☐ 61‐79 ☐ 80 or more
What CRM systems do you utilize? (select all that apply):
☐ Accela/PublicStuff ☐ Banner ☐ City Works ☐ Homegrown ☐ Microsoft ☐ Motorola ☐ Oracle ☐ Salesforce
☐ SAP ☐ SeeClickFix ☐ Sharepoint ☐ Siebel ☐ Verint / Kana ☐ Wendia ☐ RFP in Process ☐ N/AOther (Please list):
What is something that you can brag about when discussing your contact center? (i.e. attendance, engagement,
technology)
Please describe:
______________________________________________________________
Registration 1
CONTACT INFORMATION
Name:* ☐ Mr. ☐ Mrs. ☐ Ms.
Name for badge:
Title:*
Company:*
Company Mailing Address*:
City:* State/Province:*
Country: Postal Code:*
Telephone:* Fax:
E‐mail:*
*Indicates a required field
ENGAGE311 CONFERENCE REGISTRATION (Monday, April 30th – Wednesday, May 2nd) Registration fees include breakfasts, lunches, breaks, and receptions. See online agenda for more details.
$476
$556
$636
$550
☐ Early Registration Fee (through 3/15/18)
☐ Regular Registration Fee (3/16/18 – 4/25/18)☐ On‐Site Registration Fee (starts 4/26/18)
☐ CS Week Conference 42 Utility Registration (Tuesday, May 1st – Friday, May 4th)*Please note, this CS Week Conference rate only applies if you also attend ENGAGE311
Please list any food allergies and sensitivities:
Please list any special needs and considerations:
What are you professional areas of expertise? (i.e. special skills and knowledge, Six Sigma certified, analytics, HR) Please list:
What professional areas of interest do you want to discuss and learn about at ENGAGE311? Please describe:
What motivates you to attend ENGAGE311: Please describe:
______________________________________________________________
Registration 2
CONTACT INFORMATION
Name:* ☐ Mr. ☐ Mrs. ☐ Ms.
Name for badge:
Title:*
Company:*
Company Mailing Address*:
City:* State/Province:*
Country: Postal Code:*
Telephone:* Fax:
E‐mail:*
*Indicates a required field
ENGAGE311 CONFERENCE REGISTRATION (Monday, April 30th – Wednesday, May 2nd) Registration fees include breakfasts, lunches, breaks, and receptions. See online agenda for more details.
$476
$556
$636
$550
☐ Early Registration Fee (through 3/15/18)
☐ Regular Registration Fee (3/16/18 – 4/25/18)☐ On‐Site Registration Fee (starts 4/26/18)
☐ CS Week Conference 42 Utility Registration (Tuesday, May 1st – Friday, May 4th)*Please note, this CS Week Conference rate only applies if you also attend ENGAGE311
Please list any food allergies and sensitivities:
Please list any special needs and considerations:
What are you professional areas of expertise? (i.e. special skills and knowledge, Six Sigma certified, analytics, HR) Please list:
What professional areas of interest do you want to discuss and learn about at ENGAGE311? Please describe:
What motivates you to attend ENGAGE311: Please describe:
______________________________________________________________
Registration 3
CONTACT INFORMATION
Name:* ☐ Mr. ☐ Mrs. ☐ Ms.
Name for badge:
Title:*
Company:*
Company Mailing Address*:
City:* State/Province:*
Country: Postal Code:*
Telephone:* Fax:
E‐mail:*
*Indicates a required field
ENGAGE311 CONFERENCE REGISTRATION (Monday, April 30th – Wednesday, May 2nd) Registration fees include breakfasts, lunches, breaks, and receptions. See online agenda for more details.
$476
$556
$636
$550
☐ Early Registration Fee (through 3/15/18)
☐ Regular Registration Fee (3/16/18 – 4/25/18)☐ On‐Site Registration Fee (starts 4/26/18)
☐ CS Week Conference 42 Utility Registration (Tuesday, May 1st – Friday, May 4th)*Please note, this CS Week Conference rate only applies if you also attend ENGAGE311
Please list any food allergies and sensitivities:
Please list any special needs and considerations:
What are you professional areas of expertise? (i.e. special skills and knowledge, Six Sigma certified, analytics, HR) Please list:
What professional areas of interest do you want to discuss and learn about at ENGAGE311? Please describe:
What motivates you to attend ENGAGE311: Please describe:
______________________________________________________________
Registration 4
CONTACT INFORMATION
Name:* ☐ Mr. ☐ Mrs. ☐ Ms.
Name for badge:
Title:*
Company:*
Company Mailing Address*:
City:* State/Province:*
Country: Postal Code:*
Telephone:* Fax:
E‐mail:*
*Indicates a required field
ENGAGE311 CONFERENCE REGISTRATION (Monday, April 30th – Wednesday, May 2nd) Registration fees include breakfasts, lunches, breaks, and receptions. See online agenda for more details.
$476
$556
$636
$550
☐ Early Registration Fee (through 3/15/18)
☐ Regular Registration Fee (3/16/18 – 4/25/18)☐ On‐Site Registration Fee (starts 4/26/18)
☐ CS Week Conference 42 Utility Registration (Tuesday, May 1st – Friday, May 4th)*Please note, this CS Week Conference rate only applies if you also attend ENGAGE311
Please list any food allergies and sensitivities:
Please list any special needs and considerations:
What are you professional areas of expertise? (i.e. special skills and knowledge, Six Sigma certified, analytics, HR) Please list:
What professional areas of interest do you want to discuss and learn about at ENGAGE311? Please describe:
What motivates you to attend ENGAGE311: Please describe:
______________________________________________________________
Registration 5
CONTACT INFORMATION
Name:* ☐ Mr. ☐ Mrs. ☐ Ms.
Name for badge:
Title:*
Company:*
Company Mailing Address*:
City:* State/Province:*
Country: Postal Code:*
Telephone:* Fax:
E‐mail:*
*Indicates a required field
ENGAGE311 CONFERENCE REGISTRATION (Monday, April 30th – Wednesday, May 2nd) Registration fees include breakfasts, lunches, breaks, and receptions. See online agenda for more details.
$476
$556
$636
$550
☐ Early Registration Fee (through 3/15/18)
☐ Regular Registration Fee (3/16/18 – 4/25/18)☐ On‐Site Registration Fee (starts 4/26/18)
☐ CS Week Conference 42 Utility Registration (Tuesday, May 1st – Friday, May 4th)*Please note, this CS Week Conference rate only applies if you also attend ENGAGE311
Please list any food allergies and sensitivities:
Please list any special needs and considerations:
What are you professional areas of expertise? (i.e. special skills and knowledge, Six Sigma certified, analytics, HR) Please list:
What professional areas of interest do you want to discuss and learn about at ENGAGE311? Please describe:
What motivates you to attend ENGAGE311: Please describe:
______________________________________________________________
Event Name Badges
Badges can be picked up on‐site during registration hours when you check‐in. Please have each registrant take care of their
personal badge as there will be a non‐refundable replacement fee for any lost, misplaced, stolen or forgotten badge.
______________________________________________________________
Cancellation Policy
Cancellations received in writing by the registrar before April 1, 2018 will receive full refund of registration fees, less a $75 administrative processing charge. Cancellations received on or after April 1, 2018 will not receive a refund. Substitutions will be accepted. All refunds will be processed after the ENGAGE311 Conference. Please contact the CS Week 311 Manager, Amber Wiens, for any questions at [email protected] or 903‐821‐8721.
______________________________________________________________
Privacy Policy
Your information belongs to one person – you. 1. We believe your information belongs to you. 2. No one outside of CS Week has access to your e‐mail or phone numbers provided. 3. We do not sell our attendee lists or share sensitive contact information. Your personal data is a top priority. 1. The security of your personal data is important to CS Week. 2. We do not use cookies in our broadcasts to gather information. 3. We may share your personal information with third parties we hire to perform support services for us. These third parties are required to use the personal information we share with them only to perform services on our behalf and to treat your personal information as strictly confidential. 4. Any vendor contact outside the stated guidelines may originate from pre‐existing information in a vendor’s database. Photographs and video will be taken at CS WEEK. By registering for this event, you agree to allow CS WEEK Venues & Events to use your image in any CS WEEK–related publication, promotion or web site.
CIS Conference, Inc. dba CS Week TAX ID/EIN #75‐2609026
For questions or additional information regarding registration, please contact Amber Wiens, CS Week 311 Manager at (903) 821‐8721 or [email protected].