CBDC Cruise Intake Form

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Thank you for expressing interest in attending the November Crypto.Blockchain.Defi.Conversation Cruise. Please complete this intake form and our Travel Agent will contact you to book your cabin.

Date *

YYYY

Complete Name

Home Address *

Billing Address *

Area Code & Telephone Number *

Citizenship *

How many people will be attending the cruise? *

How many cabins will you need? *

Do you have a cabin preference? *

Will you be applying as a Speaker? *

Yes

Would you like to participate in the Hackathon? *

Yes

Maybe

Would you like to sponsor the Hackathon? *

Yes

Maybe

Would you like to be a Mentor for the Hackathon? *

Yes

Maybe

If you are applying to Speak, please indicate your areas of knowledge *

If associated with a company, please list your website *

Please list your country of origin. *

Will you be applying as a Sponsor? *

Yes

Have you received the Sponsorship package? *

Yes

Are you a member of the Blockchain Legal Institute to receive a discount on your tickets? *

Yes

Are you a member of the Government Blockchain Association to receive a discount on your tickets? *

Yes

Are you interested in Conference Group Tickets discount rates? (Note: There is no discount on cabin rates.) *

Yes

Are you interested in the Media discount rate? *

Yes

Email *

I understand that I will be asked to deposit $50 for each cabin reserved upon conversation with the conference travel agent. I am ready to reserve. *

Yes

I understand I will be required to purchase Travel Insurance for this cruise. Information will be collected for the travel insurance. *

Yes