The death, injury, or illness happening to the attendee or exhibitor or a member of their immediate family who is under the age of 70.

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* 1. Contact Information

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* 2. Name of Registration Purchaser

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* 3. Registration Price Paid (in USD)

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* 4. Registration Number

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* 5. Date Purchased

Date

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* 6. When did you become aware that you would not be able to attend the Event Please provide all details.

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* 7. Please be advised we require a death certificate or doctor’s note confirming the details. Upload the required documents below.

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.
Choose File

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* 8. Name of person who suffered the death, injury or illness.

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* 9. Relationship to you.

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* 10. Nature of accident or illness.

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* 11. If illness, when was it first diagnosed?

Date

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* 12. If accident, how and when did the accident occur?

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* 13. Why did this incident prevent this person from attending the event?

T