2026 Massage Board Executive Summit Registration

Massage Board Executive Summit Registration

Providence, Rhode Island | April 22-24, 2026
Name*

First NameLast Name
Preferred First Name
(This name will be printed on your badge)
Email*
example@example.com
Official Title*
Board/Agency*
Full Official Name
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone*
Business Email*
example@example.com
Cell Phone*
(For emergency use only)
Emergency Contact Name*

First NameLast Name
Emergency Contact Relationship to Attendee
Emergency Contact Phone Number*
Allergies/Special Requests
Arrival Date*

MonthDayYear
Departure Date*

MonthDayYear
By registering for this meeting, I give permission to FSMTB to freely use my image or likeness in photographs or audio/visual recordings that may be taken during the MBE Summit for the purpose of promoting FSMTB programs and services. I understand these images may be used on the FSMTB website, publications, social media, and other lawful purposes. I also consent to allow FSMTB to share my business contact information with other MBE Summit attendees.*

YesNo
Registration Type*

Executive Director/Chief Administrator ($0.00)Additional Staff Member ($350.00)Legal Counsel ($350.00)Speaker/Presenter ($0.00)
Form of Payment (receipt will be sent to the business email address provided above)*

Credit CardInvoice

Credit Card Payment

Additional Staff Member

$350.00 Quantity

Legal Counsel

$350.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country