2027 ERA Conference Attendee Registration Form « Electronics Representatives Association

STOP! Is your company planning on registering for a sponsorship level that comes with complimentary registration(s)? If so, please register for the sponsorship + complimentary registrations HERE.

Company Name *

City/State

Country

ATTENDEE TYPE

Is your company an ERA member? *

YES
NO
No, but interested in membership

Interested in ERA membership? Contact Ama Derringer, Membership Coordinator, at aderringer@era.org for more information.

Choose the correct REGISTRATION RATE **and QUANTITY** from the below dropdown menu. *

List All Conference Attendees Below

Please include email and cell phone info for ALL attendees below so we may provide them with updates and other important information about the 2027 ERA Conference.

If you do not know attendees names right now, please enter “TBA” in the name fields.

ATTENDEE 1

Attendee 1 Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 1 – Email Address:

Attendee 1 – City/State of Work:

Attendee 1 – Cell Phone #:

Attendee 1 – Title/Role:

ATTENDEE 2

Attendee 2 Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 2 – Email Address:

Attendee 2 – City/State of Work:

Attendee 2 – Cell Phone #:

Attendee 2 – Title/Role:

ATTENDEE 3

Attendee 3 Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 3 – Email Address:

Attendee 3 – City/State of Work:

Attendee 3 – Cell Phone #:

Attendee 3 – Title/Role:

ATTENDEE 4

Attendee 4 Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 4 – Email Address:

Attendee 4 – City/State of Work:

Attendee 4 – Cell Phone #:

Attendee 4 – Title/Role:

ATTENDEE 5

Attendee 5 Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 5 – Email Address:

Attendee 5 – Cell Phone #:

Attendee 5 – Title/Role:

Attendee 5 – City/State of Work:

ATTENDEE 6

Attendee 6 Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 6 – Email Address:

Attendee 6 – City/State of Work:

Attendee 6 – Cell Phone #:

Attendee 6 – Title/Role:

ATTENDEE 7

Attendee 7 Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 7 – Email Address:

Attendee 7 – City/State of Work:

Attendee 7 – Cell Phone #:

Attendee 7 – Title/Role:

ATTENDEE 8

Attendee 8 – Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 8 – Email Address:

Attendee 8 – Title/Role:

Attendee 8 – Cell Phone #:

Attendee 8 – City/State of Work:

ATTENDEE 9

Attendee 9 – Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 9 – Email Address:

Attendee 9 – Cell Phone #:

Attendee 9 – City/State of Work:

Attendee 9 – Title/Role:

ATTENDEE 10

Attendee 10 – Full Name:

First

Last

First-time attendee?

Yes
No

Attendee 10 – Email Address:

Attendee 10 – Cell Phone #:

Attendee 10 – City/State of Work:

Attendee 10 – Title/Role:

Please submit your secure online payment:

Please list below a name and email address of the person to whom the electronic receipt should be emailed.

Contact Name (for Electronic Receipt) *

First

Last

Email Address (for Electronic Receipt) *

Total *

$0.00

Credit Card *

Card

Name on Card

-> Questions about the event, venue or hotel room reservations? Contact Kate Van Hise, ERA Events Manager, at kvanhise@era.org.

-> Questions about Conference registration or payment? Contact Karin Derkacz, ERA Operations Director, at kderkacz@era.org

2027 ERA Conference – Attendee Registration Form

STOP! Is your company planning on registering for a sponsorship level that comes with complimentary registration(s)? If so, please register for the sponsorship + complimentary registrations HERE.

Interested in ERA membership? Contact Ama Derringer, Membership Coordinator, at aderringer@era.org for more information.

List All Conference Attendees Below

Please include email and cell phone info for ALL attendees below so we may provide them with updates and other important information about the 2027 ERA Conference. If you do not know attendees names right now, please enter “TBA” in the name fields.

ATTENDEE 1

ATTENDEE 2

ATTENDEE 3

ATTENDEE 4

ATTENDEE 5

ATTENDEE 6

ATTENDEE 7

ATTENDEE 8

ATTENDEE 9

ATTENDEE 10

Please submit your secure online payment:

Please list below a name and email address of the person to whom the electronic receipt should be emailed.

-> Questions about the event, venue or hotel room reservations? Contact Kate Van Hise, ERA Events Manager, at kvanhise@era.org. -> Questions about Conference registration or payment? Contact Karin Derkacz, ERA Operations Director, at kderkacz@era.org

Please include email and cell phone info for ALL attendees below so we may provide them with updates and other important information about the 2027 ERA Conference.

If you do not know attendees names right now, please enter “TBA” in the name fields.

-> Questions about the event, venue or hotel room reservations? Contact Kate Van Hise, ERA Events Manager, at kvanhise@era.org.

-> Questions about Conference registration or payment? Contact Karin Derkacz, ERA Operations Director, at kderkacz@era.org