Badge and Terms Form

2025 FICP Annual Conference Badge and Terms Form

We look forward to seeing you at the 2025 FICP Annual Conference. Please fill out the below fields so we can have a badge prepared for you.

First Name

Last Name

Designation

If you would like to add your preferred pronouns to your badge, please select one of the following preferences.

She/Her/Hers

He/Him/His

They/Them/Theirs

I prefer name only

Email Address

Phone Number

Company

City

State

If you have any dietary restrictions, please detail your requirements in the box below.

If you have any special needs, accommodations or requirements pursuant with the Americans with Disability Act (ADA), please detail your requirements in the box below.

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

The FICP Event Registration Terms & Conditions apply to this event. By selecting this checkbox, you acknowledge and accept the Terms & Conditions contained herein. Should you not wish to accept, you should not register. Submission of a registration is regarded as affirmation of your acceptance on behalf of yourself and/or the registrant(s) of the FICP Event Registration Terms & Conditions.

FICP is committed to creating a safe, productive, and welcoming environment that is inclusive and free from discrimination and harassment. By selecting this checkbox, you agree to abide by FICP's Code of Conduct, which states there is zero-tolerance for any form of discrimination or harassment.

By selecting this checkbox, you also acknowledge personal information you provide may be used in accordance with our Privacy Policy.

I accept the FICP Event Registration Terms & Conditions, agree to abide by FICP’s Code of Conduct and acknowledge my personal information will be used in accordance with our Privacy Policy. *

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