MODERE MEETUP HOST REGISTRATION (October 19th & 20th) Question Title * 1. Please enter your name. Question Title * 2. Please enter your email address. Question Title * 3. Please enter your phone number. Question Title * 4. What is your Modere Meetup location address? Question Title * 5. What is your Modere Meetup registration link? For your Meetup to be posted to the Modere Events Page, you must provide a valid registration link at the time of registration. Question Title * 6. What is the date and time of your Modere Meetup? Date / Time Date Time AM/PM - AM PM Question Title * 7. Please upload a proof of attendance list. (This will be used to determine incentive eligibility. These are DUE by October 7th to qualify for incentives. Please email registration lists to moderemeetup@modere.com) DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please upload a proof of attendance list. (This will be used to determine incentive eligibility. These are DUE by October 7th to qualify for incentives. Please email registration lists to moderemeetup@modere.com) Question Title * 8. I acknowledge that any cost associated with hosting my Modere Meetup will be at my own expense. Yes Done