Impact Physician Workshop & Retreat – Sign up

Impact Physician Workshop-Retreat Registration - Golden, CO

All Workshops begin on day-one at 3:00 PM MT and end on day-three with dinner from 6:00-9:00 PM MT.
If you have multiple Registrants, please complete this online form for each one.

Medical Practice Information

Registration Limited to MD or DO.
If not listed, please choose "Other..." and add below.
If Other chosen above, or you have more than one specialty, please separate each with a comma.
If not listed, please choose "Other..." and add below.
If Other chosen above, or you have more than one specialty, please separate each with a comma.
Tell us about your current situation and why you want to attend the Impact Physician Workshop & Retreat.

Impact Physician Workshop & Retreat (IPWR)

Registration Agreement


     This Impact Physician Workshop and Retreat Agreement (“Event”) occurring on, Oct 7-9, 2021, (“Dates”) is made on the Date Signed below (the “Effective Date”) between Impact Physician, with its principal address at 4833 Front St, Castle Rock, CO 80104 (“Impact”), and the Name and Address of the person entered above in this registration form (the "Registrant").


Event Agreement Information

Event Times: Thursday, 3:00 pm MT to Saturday, 9:00 pm MT (“Times”)

Event Location: Golden, CO (“Location”)

Event Description: XXXXX (“Description”)

Registration: Opens Aug 24th, closes Oct 3rd. Registration is limited.


Payment

Registration Fee: Two thousand four hundred and ninety-five ($2,495.00) US dollars. Payable at the time of online registration. Pre-registration required—no walk-in registrations accepted.


Scope

Included Items: a) all speaker fees; b) vendor meetings; c) workshops; d) all meals; e) refreshment breaks during Event; f) three (3) nights lodging at Origin Hotel, g) transportation to/from hotel to event site; h) taxes; and, i) food and transport gratuities.


Not-included Items: a) Travel costs to and from the Event; b) initial Thursday transportation from Denver airport to the Event hotel; c) return transportation Sunday morning, Oct 10th from the Event hotel to airport for departure; d) personal, incidental hotel charges for food, beverages, entertainment, and supplies.


Cancellation

A refund of the Event Fee is made to the Registrant if the Event is canceled by Impact on or before October 6, 2021. The Event Fee and Registrant-paid expenses are non-refundable whether, a) Registrant cancels prior to the Event; or b) regardless of the Registrant’s length of stay at the Event. Registrant pre-purchased travel and other expenses are not refundable by Impact for any reason.


Termination

The Event may be terminated without refund or recourse due to unforeseeable Force Majeure conditions beyond either party’s control: including, but not limited to, incidents involving all Registrants and Impact’s staff such as, extreme weather conditions, government shutdown, pandemic, US-involved war, or other disaster.


Indemnification

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Photo Release

Registrant agrees to give Impact their unconditional permission to use and edit photos taken during the Event for business and marketing purposes.

Please sign your name with your mouse or with your finger/pen on your touch-screen.

Registration Payment Section

Price: $ 2,495.00
This fee is for your workshop registration as per the Terms and Conditions of the "IPWR Registration Agreement" signed above.
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