ImpACT Registration

We are excited to see you at ImpACT 2023! Please fill out the registration form below. Please note that each attendee will need to complete this form.

Name*
First Last
Email*
Phone*
County*
What County are you joining from?
Title / Position*
Which day would you like to attend?
- September 15th (Southwest Indianapolis)
- September 22nd (Northeast Indianapolis)
ImpACT - September 15th Event Info
Click Here to view Event Location
Click Here to book a hotel
ImpACT - September 22nd Event Info
Click Here to view Event Location
Click Here to book a hotel
How many attendees will be attending from your department?*
Please list the names of all Attendees
One name per line
Are you in need of CPR recertification? If so, how many?
- Yes
- No
How Many

ImpACT - September 15th Event Info

ImpACT - September 22nd Event Info