September 10-13, 2019 Harbor View Hotel 131 North Water Street, Edgartown, MA 02539 Registration deadline for Life at the Vineyard is August 12, 2019 Event ID 2529 Life at the Vineyard Date(s)09/10-09/13 Step 1 of 3 0% Email:* Select Registration Type:*Attendee Personal Information:Name:* First Last Company Name: Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Office Phone:*Cell Phone:*Emergency Contact Name:* First Last Emergency Phone:*Please list any medically necessary dietary needs: Travel Information:Travel arrangements will be made through our designated travel partner, Direct Travel. Once you submit your registration form, you will be contacted via email with a flight itinerary containing the best available schedule and fare from the closest major airport. Please confirm your schedule within 24 hours of having been contacted by Direct Travel by either responding to the email or placing a call to them. Your response to Direct Travel within 24 hours of receipt will hold your seats on the proposed itinerary, but does not guarantee the rate until time of booking.Will you be driving or flying?*DrivingFlyingAre you bringing a guest?*YesNoName as it appears on Driver's License:* First Middle Last Date of Birth:* MM slash DD slash YYYY (Required for air reservations)Gender:*MaleFemaleDesired departure city or airport code:* Seat Preference:*AisleWindowTSA Pre-check # (if applicable): Please share any special travel needs: Guests:If your guest is not traveling from the same city as you, please list their travel information in the special travel needs section above.Guest's Name as it appears on their Driver's License:* First Middle Last Guest Date of Birth:* MM slash DD slash YYYY (Required for air reservations)Guest Gender:*MaleFemaleGuest TSA Pre-check # (if applicable): HotelHotel Information:* Please secure hotel check-in September 10 and check-out September 13. Please secure hotel check-in and check-out for other dates (below). I do not need a hotel room. Please note, your room is complimentary during event dates. Additional nights are based on availability with the property and will be at your own expense. What is your arrival date?*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What is your departure date?*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Terms and Conditions:* Do you agree to the terms and conditions?ASSUMPTION OF RISK With your submission of this registration for your Client One rep event, you will be accepting the risks involved with this event. These risks may include, but are not limited to: acts of God; terrorism; use of roads, vehicles, accident or illness, or consumption of alcohol by you or others. You agree to be responsible for your own welfare, and accept any and all risks of unanticipated events, illness, injury or death. We expect all guests to exemplify our high ethics, standards and professional code of conduct with which our company prides itself. Any issues brought to our attention that are not reflective of this will be handled on a case-by-case basis and when applicable, at the expense of the offender. RELEASE For being permitted to participate in the Program, you hereby Release and discharge Client One, CreativeOne, Conference Event Management, Direct World Travel, their employees, agents, and others assisting or otherwise affiliated with the program from any claims, damages, and liability of any kind associated with your participation in the program except liability for those willful or malicious acts by the sponsors. The sponsors shall have no responsibility for any injuries, losses, or damages of any kind resulting from your participation in the program and the sponsors shall be held harmless against any claims of liability arising directly or indirectly from your participation in the program or any injury, accident, illness, or damages (including death). By Registering you are authorizing Client One and its designees the right to use your name, likeness, image, voice, appearance, and performance as embodied in the Product whether recorded on or transferred to videotape, film, slides, photographs, audio tapes, or other media, now known or later developed.