4. QUESTIONNAIRE This section must be completed to process your registration and create your event badge. HOW TO REGISTER PRIORITY CODE: Online: http://sesconference.com/toronto/ By Fax: 646-390-9885 By Phone: 1 800-955-2719 By Mail: registration@sesconference.com If you have a priority code, please enter it here: COMPLETE SECTIONS 1-4. Please print or type your information. To submit multiple registrations, please download and complete this form for each registration. 1. PERSONAL INFORMATION What is your role in your organization? ○Search Marketing ○Social Media Marketing ○Sales ○Product/Brand Marketing ○Media Planning ○General Management Please fill out form completely and mail or fax with payment to the address below. Name: What is your title? ○Analyst ○Consultant ○Department Manager/Manager ○Owner /President/CEO/Partner ○VP Corporate Title: Company Name: Street Address: City: State/Prov: Zip/Postal Code: Country: Tel: Fax: 2. PACKAGE SELECTION Dates Pre-Show ☐ All Access Pass September 10-13 $2,500 ☐ Platinum Pass September 11-13 $2,000 ☐ Two-Day Pass Any 2 conf. days $1,600 Any 1 conf. day $1,000 ** Please select which day(s) you will be attending (1or 2 Day Pass Only) ☐ Expo Hall Pass September 11-12 Wednesday Thursday Friday Free ☐ Onsite Training (1/2 day) September 10 $950 ☐ Onsite Training (full day) September 10 $1,500 Group Pricing (for groups of 4 or more) * ☐ All Access Pass ☐ Platinum Pass ☐ Two-Day Pass ☐ One-Day Pass September 10-13 September 11-13 Any 2 conf. days Any 1 conf. day $1,895/pass $1,425/pass $1,100/pass $700/pass All Access Pass Onsite Training (September 10) ☐ How to Collect, Interpret & Use your Web Analytics Data (AM ) ☐ Content Marketing: Implementing a Winning Program (AM ) ☐ How to Create a PPC Management Master Program (AM ) ○C-Level ○Coordinator/Associate ○Director ○EVP/SVP ○Other How many people are employed at your company? ○Over 5,000 ○100-999 ○1,000-4,999 ○50-99 August 16 – September 6 ☐ One-Day Pass ○Other ○PR ○Press What is your area of interest? (check all that apply) ☐Analytics Measurement & Attribution ☐Media Buying ☐Email Solutions & Services ☐SEO Software & Services ☐Content Creation Management Services ☐Paid Search ☐E-Commerce Services & Solutions ☐Video Services ☐Social Media Services ☐Local Search ☐Behavioral Marketing Services ☐Mobile Solutions Locations Email address: Conference Passes In what industry do you and/or your clients operate? ○Automotive ○Media/Publishing ○Education ○Travel/Hospitality ○Finance/Banking ○Government/Healthcare ○Industrial ○Pharmaceutical/Biotechnology ○Real Estate ○Retail/e-Commerce ○Restaurant/Food Services ○Legal ○Manufacturing ○Tech/Software ○Service Provide ○Telecom ○Other ☐ Adaptive Agile Marketing (PM ) ☐ Advanced Keyword Research & Management (PM ) ○49-fewer Do you plan to purchase, update or hire any of the following in the near future? (check all that apply) ☐Paid Search Technology/Vendor ☐SEO Technology/Vendor ☐Social Media Technology/Vendor ☐Analytics Technology/Vendor ☐Ad Networks/Exchange Platform ☐Ad Agency ☐None of the Above Are you a member of any of the following associations? (check all that apply) ☐SEMPO ☐ MMA ☐DMEF ☐DMA ☐ Social Media Club ☐IAB ☐None of the Above ☐Other (please specify)________________ What is your role in the purchasing process? ○Approve ○I have No Involvement in Purchasing Decisions ○Recommend ○Research What is your annual corporate marketing budget? ○5M+ ○500k-999k ○Under 100k ○1M-4.99M ○100k-499k ○I Don’t Know Mail your completed registration form with payments to: Incisive Interactive Marketing, Attn: Accounts Receivable nd 55 Broad Street, 22 Floor, New York, NY 10004 (checks payable to Incisive Interactive Marketing LLC) ☐ Mobile & the New Frontier (PM) ☐ Email Marketing: Driving 51% Engagement (Full Day) * All group pass holders must register at the same time and be from the same company. Group discounts do not apply to Training and cannot be combined with any other discounts. Savings is taken off the Full Price only. Please check the box below once you have completed this form ☐ I have read and understood the registration policies, including the terms of cancellations, substitutions & changes. 3. PAYMENT METHOD Payment in U.S. funds MUST accompany this form for your registration to be processed. Card Holder’s Name: Credit Card Type: ○Visa Credit Card Number: Month/Year Card Expires: Signature of Card Holder: ○MasterCard ○American Express REGISTRATION POLICIES: CANCELLATIONS, SUBSTITUTIONS & CHANGES: Incisive Interactive Marketing LLC reserves the right to make changes to the events program. Unforeseen circumstances may result in the substitution of a presentation, topic or speaker. You consent to the Incisive Interactive Marketing LLC recording and/or photographing the event and using such items, including your likeness, in future promotions. Incisive Interactive Marketing LLC reserves the right to reject or rescind any registration and return any fees accordingly. Registrant assumes all risks incidental to participation in all event activities, including loss or damage to property. Incisive Interactive Marketing LLC’s total liability shall be limited to the amount of fees received, if any from a particular registrant If you must cancel for any reason, notify our registration department in writing by th fax 646-390-9885 or email at registration@sesconference.com by August 9 , 2013. Your registration th will be refunded less a $100 processing fee. Cancellations after August 9 , 2013 are non-refundable, regardless of when you registered. If you cannot attend the event due to unforeseen circumstances, you may transfer your registration to another person. You may not transfer your registration once your badge has been picked up.