DETWC2 - The Millennium Alliance

Digital Enterprise Transformation West

Green Valley Ranch, Henderson, Nevada

August 22, 2019 - August 23, 2019

Event: Salesforce.com ID

Event Code

Contact: Salesforce.com ID

No Cancellation:

No Cancellation

Delegate Reco Submitted:

Delegate Reco Submitted

Event Specific Questions:

RetailMarketingHealthcare ProvidersHealthcare PayersDigital Healthcare

Registration Form (always check):

Converted

Name & Contact Information

First Name

Preferred

Last Name

Preferred

Job Title

Company

Phone

Mobile

Assistant Name & Contact Information

Assistant Name

Assistant Email

Assistant Phone

I live locally, or I am driving.

I am booking my own flights.

Flight & Travel

First Name

AS PER ID

Middle

AS PER ID

Last Name

AS PER ID

Date of Birth

Known Traveler Number (if applicable)

Gender

Preferred City of Departure

Preferred City of Return (if different)

Airline Preference #1

Frequent Flyer Number #1

Airline Preference #2

Frequent Flyer Number #2

Airline Preference #3

Frequent Flyer Number #3

Objectives & Leadership

How many people report to you (directly & indirectly)?

What are your key departmental / enterprise objectives over the next 6-12 months?

What is your current technology stack?

How many stores do you operate?

What is your annual ad spend?

How many beds are in your facility / system?

How many beds are in your facility / system? (if applicable)

How many members are enrolled in your plan(s)?

What is your total budget over the next 12-month period?

Describe your Project/Initiative. What are your objectives?

What are the anticipated non-budgetary challenges?

What 3rd party partners would you be interested in working with or hearing more about?

What is your timeline for project completion?

What is the total budget for this project?

Please indicate any C-Level Executives / Industry Peers you would like to recommend attend the upcoming assembly:

Please indicate any technology vendors or service providers you would like to recommend to attend the upcoming assembly:

Payment Information

We Accept: Visa, Mastercard, American Express

Registration Fee:

$800.00 (Honored Attendee VIP)$2,500.00

Cardholder Name

Card Number

CVC Code

Terms & Conditions

1. OUR COMMITMENT TO YOU:
Millennium Alliance LLC will arrange a mutually agreed upon itinerary. Please note that schedules are subject to change. Any changes will be communicated to you promptly. You will be able to request appointments with any of the companies and individuals in attendance. Millennium Alliance LLC will endeavor to schedule these meetings on your behalf without guaranteeing them. We reserve the right to determine the theme, scope and content of meetings, workshops and speeches to be held during the assembly and to vary the program and/or its content as deemed necessary. Should the event be canceled for reasons or circumstances beyond Millennium Alliances LLC control, we hereby reserve the right to reschedule the assembly upon written notice to you. Every effort must be made to attend rescheduled dates. If you are unable to attend for whatever reason, written notice must be provided within 48h of the rescheduled notice.

2. VIP ATTENDEE COMMITMENT:
You agree to participate in the program as outlined in the package details. Meetings will be pre-confirmed/pre-assigned with executives. You also agree to attend for the entire duration of the assembly. Millennium Alliance LLC will organize your transportation and accommodation. If an attendee misses their flight they are responsible for transportation to the assembly. Only named and pre-registered attendees may attend the event. Attendees are responsible for their own insurance (including, but not limited to travel insurance, personal effects, and personal insurance), vaccinations and visas (where applicable). By confirming your attendance with the below signature, Millennium Alliance LLC maintains the right to associate your name and organization to the assembly through our customer facing promotional materials.

3. TRAVEL, FOOD, AND BEVERAGE:
Millennium Alliance LLC will agree to pay for pre-agreed standard airfare, transfers to and from the assembly venue and accommodations for the duration of the assembly. Millennium Alliance LLC will provide food and beverage throughout the official assembly hours. Any additional costs incurred by the attendee will be his/her responsibility.

4. SUBSTITUTION AND CANCELLATION:
Millennium Alliance LLC has invited you specifically and has prepared programs, meetings, travel, accommodation, food and beverage as outlined in your package. Should you be unable to attend, you must make every effort to provide a replacement attendee from within your company/organization. Any attendee substitutions must be approved by Millennium Alliance LLC in advance of the assembly. Millennium Alliance LLC will only accept replacement attendees of equal or senior standing from within your organization, and from a department that is relevant to the assembly program. Should a replacement be accepted, any non-transferable costs will be billed to the original attendee/company. Full cancellations (without an accepted replacement) must be confirmed in writing and you shall pay Millennium Alliance LLC $1,500 in liquidated damages caused by your non-attendance. In the event Millennium Alliance LLC purchases a flight but the executive cancels or does not attend, Millennium Alliance LLC reserves the right to invoice the delegate in full for the cost of the flight. Alternatively, at Millennium Alliance LLC’s discretion, we can use the flight credit towards a future Millennium Alliance LLC program within 12 months from the event date.

5. GENERAL:
This agreement shall be governed by and construed in accordance with the laws of the state of New York without regard to the conflicts of law provisions of such a state. The undersigned by signing this form hereby agrees and submits him/herself to the exclusive personal and subject matter jurisdiction of the federal and New York state courts located in or having jurisdiction over New York City, New York. The undersigned hereby states that it will accept service of process by certified mail addressed to the undersigned at his/her place of business or by any manner permitted by the laws of the state of New York. In the event this under signs fails to pay Millennium Alliance LLC according to this agreement, the undersigned promises to pay any and all expenses, including legal fees, Millennium Alliance LLC incurs in commencing or maintaining any claims arising out of this agreement.

I understand that by completing this form, I am agreeing to The Millennium Alliance's Terms and Conditions.

Terms & Conditions

1. OUR COMMITMENT TO YOU:
Millennium Alliance LLC will arrange a mutually agreed upon itinerary. Please note that schedules are subject to change. Any changes will be communicated to you promptly. You will be able to request appointments with any of the companies and individuals in attendance. Millennium Alliance LLC will endeavor to schedule these meetings on your behalf without guaranteeing them. We reserve the right to determine the theme, scope and content of meetings, workshops and speeches to be held during the assembly and to vary the program and/or its content as deemed necessary. Should the event be canceled for reasons or circumstances beyond Millennium Alliances LLC control, we hereby reserve the right to reschedule the assembly upon written notice to you. Every effort must be made to attend rescheduled dates. If you are unable to attend for whatever reason, written notice must be provided within 48h of the rescheduled notice.

2. VIP ATTENDEE COMMITMENT:
You agree to participate in the program as outlined in the package details. Meetings will be pre-confirmed/pre-assigned with executives. You also agree to attend for the entire duration of the assembly. Millennium Alliance LLC will organize your transportation and accommodation. If an attendee misses their flight they are responsible for transportation to the assembly. Only named and pre-registered attendees may attend the event. Attendees are responsible for their own insurance (including, but not limited to travel insurance, personal effects, and personal insurance), vaccinations and visas (where applicable). By confirming your attendance with the below signature, Millennium Alliance LLC maintains the right to associate your name and organization to the assembly through our customer facing promotional materials.

3. TRAVEL, FOOD, AND BEVERAGE:
Millennium Alliance LLC will agree to pay for pre-agreed standard airfare, transfers to and from the assembly venue and accommodations for the duration of the assembly. Millennium Alliance LLC will provide food and beverage throughout the official assembly hours. Any additional costs incurred by the attendee will be his/her responsibility.

4. SUBSTITUTION AND CANCELLATION:
Millennium Alliance LLC has invited you specifically and has prepared programs, meetings, travel, accommodation, food and beverage as outlined in your package. Should you be unable to attend, you must make every effort to provide a replacement attendee from within your company/organization. Any attendee substitutions must be approved by Millennium Alliance LLC in advance of the assembly. Millennium Alliance LLC will only accept replacement attendees of equal or senior standing from within your organization, and from a department that is relevant to the assembly program. Should a replacement be accepted, any non-transferable costs will be billed to the original attendee/company. In the event Millennium Alliance LLC purchases a flight but the executive cancels or does not attend, Millennium Alliance LLC reserves the right to invoice the delegate in full for the cost of the flight. Alternatively, at Millennium Alliance LLC’s discretion, we can use the flight credit towards a future Millennium Alliance LLC program within 12 months from the event date.

5. GENERAL:
This agreement shall be governed by and construed in accordance with the laws of the state of New York without regard to the conflicts of law provisions of such a state. The undersigned by signing this form hereby agrees and submits him/herself to the exclusive personal and subject matter jurisdiction of the federal and New York state courts located in or having jurisdiction over New York City, New York. The undersigned hereby states that it will accept service of process by certified mail addressed to the undersigned at his/her place of business or by any manner permitted by the laws of the state of New York. In the event this under signs fails to pay Millennium Alliance LLC according to this agreement, the undersigned promises to pay any and all expenses, including legal fees, Millennium Alliance LLC incurs in commencing or maintaining any claims arising out of this agreement.

I understand that by completing this form, I am agreeing to The Millennium Alliance's Terms and Conditions.

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