{"id":3142,"date":"2026-04-01T17:37:37","date_gmt":"2026-04-01T17:37:37","guid":{"rendered":"https:\/\/geekedconvention.com\/?page_id=3142"},"modified":"2026-04-01T18:16:23","modified_gmt":"2026-04-01T18:16:23","slug":"geeked-registration","status":"publish","type":"page","link":"https:\/\/geekedconvention.com\/?page_id=3142","title":{"rendered":"GeekED Registration"},"content":{"rendered":"<style id=\"wpforms-css-vars-3478-block-15046b60-05a4-4193-8aed-6396f51a5fbd\">\n\t\t\t\t#wpforms-3478.wpforms-block-15046b60-05a4-4193-8aed-6396f51a5fbd {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-quiz wpforms-square wpforms-block wpforms-block-15046b60-05a4-4193-8aed-6396f51a5fbd wpforms-render-modern\" id=\"wpforms-3478\"><form id=\"wpforms-form-3478\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3478\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F3142\" data-token=\"f96b674165c7dd628b76d93d0f7b553f\" data-token-time=\"1778578875\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\">\t\t<div id=\"wpforms-3478-field_4-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"4\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-3478-field_4\" >Address Attendee 2026<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-3478-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-3478-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Attendee Name<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3478-field_1\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-3478-field_1-error\" ><label for=\"wpforms-3478-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3478-field_1-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-3478-field_1-last-error\" ><label for=\"wpforms-3478-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3478-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-3478-field_2\">Email Address<\/label><input type=\"email\" id=\"wpforms-3478-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-3478-field_2-error\" ><\/div><div id=\"wpforms-3478-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-3478-field_3\">Phone Number<\/label><input type=\"tel\" id=\"wpforms-3478-field_3\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" aria-label=\"Phone Number\" aria-errormessage=\"wpforms-3478-field_3-error\" ><\/div><div id=\"wpforms-3478-field_7-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3478-field_7\">Professional Board for CE Certification  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-3478-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"APA\"  class=\"choice-1 depth-1\"  >APA<\/option><option value=\"ASBW\"  class=\"choice-2 depth-1\"  >ASBW<\/option><option value=\"APT\"  class=\"choice-3 depth-1\"  >APT<\/option><option value=\"NBCC\"  class=\"choice-4 depth-1\"  >NBCC<\/option><option value=\"Gambling and Addiction Board\"  class=\"choice-5 depth-1\"  >Gambling and Addiction Board<\/option><option value=\"Other\"  class=\"choice-6 depth-1\"  >Other<\/option><\/select><\/div><div id=\"wpforms-3478-field_8-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-payment-quantities-enabled\" data-field-type=\"payment-single\" data-field-id=\"8\"><label class=\"wpforms-field-label\">GeekED 2026 LAN Party Virtual Conference <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-single-item-price-content\"><div class=\"wpforms-single-item-price wpforms-field-medium wpforms-field-required wpforms-payment-price\">Price: <span class=\"wpforms-price\">&#036;250.00<\/span><\/div><select id=\"wpforms-3478-field_8-quantity\" class=\"wpforms-payment-quantity\" name=\"wpforms[quantities][8]\" required=\"required\"><option value=\"0\"  selected='selected' >0<\/option><option value=\"1\"  >1<\/option><option value=\"2\"  >2<\/option><option value=\"3\"  >3<\/option><option value=\"4\"  >4<\/option><option value=\"5\"  >5<\/option><option value=\"6\"  >6<\/option><option value=\"7\"  >7<\/option><option value=\"8\"  >8<\/option><option value=\"9\"  >9<\/option><option value=\"10\"  >10<\/option><\/select><\/div><input type=\"hidden\" id=\"wpforms-3478-field_8\" class=\"wpforms-field-medium wpforms-field-required wpforms-payment-price\" data-rule-required-positive-number=\"1\" name=\"wpforms[fields][8]\" value=\"&#036;250.00\" aria-describedby=\"wpforms-3478-field_8-description\"><div id=\"wpforms-3478-field_8-description\" class=\"wpforms-field-description\">Full Access Pass \nAccess to all live GeekED 2026 sessions across both days\nOpportunities to engage with presenters and attendees in real time\nA fully virtual, interactive conference experience designed for accessibility and connection\nContinuing education opportunities aligned with Geek Therapeutics standards. And digital access to courses missed later in the fall!<\/div><\/div><div id=\"wpforms-3478-field_9-container\" class=\"wpforms-field wpforms-field-payment-coupon\" data-field-type=\"payment-coupon\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-3478-field_9\">Coupon<\/label><div class=\"wpforms-field-payment-coupon-wrapper\">\n\t\t\t\t<div class=\"wpforms-field-payment-coupon-input-wrapper\">\n\t\t\t\t\t<input type=\"text\" id=\"wpforms-3478-field_9\" class=\"wpforms-field-medium wpforms-field-payment-coupon-input\" data-rule-coupon=\"1\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-3478-field_9-error\" aria-describedby=\"wpforms-3478-field_9-description\" >\n\t\t\t\t<\/div>\n\t\t\t\t<button type=\"button\" aria-live=\"assertive\" class=\"wpforms-field-payment-coupon-button\">Apply<\/button>\n\t\t\t<\/div>\n\t\t\t<div class=\"wpforms-field-payment-coupon-applied-coupons\"><\/div><div id=\"wpforms-3478-field_9-description\" class=\"wpforms-field-description\">If you have applied for reduced attendance costs and have been provided a discount code, please submit that here. <\/div><\/div><div id=\"wpforms-3478-field_10-container\" class=\"wpforms-field wpforms-field-square\" data-field-type=\"square\" data-field-id=\"10\"><label class=\"wpforms-field-label\">Square <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-square-number\"><div id=\"wpforms-3478-field_10\" class=\"wpforms-field-square-cardnumber wpforms-field-required\" aria-errormessage=\"wpforms-3478-field_10-error\" data-required=\"required\"><!-- Square credit card will be inserted here. --><\/div><input\n\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\tclass=\"wpforms-square-credit-card-hidden-input\"\n\t\t\t\t\t\tname=\"wpforms[square-credit-card-hidden-input-3478]\"\n\t\t\t\t\t\tid=\"wpforms-square-credit-card-hidden-input-3478\"\n\t\t\t\t\t\tstyle=\"display: none;\" disabled><label  class=\"wpforms-field-sublabel after\">Card<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-square-name\"><input type=\"text\" id=\"wpforms-3478-field_10-cardname\" class=\"wpforms-field-square-cardname wpforms-field-required\" name=\"wpforms[fields][10][cardname]\" aria-errormessage=\"wpforms-3478-field_10-cardname-error\" required><label  class=\"wpforms-field-sublabel after\">Name on Card<\/label><\/div><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-3478-field_4-container { position: absolute !important; 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