EmpowerFest 2023
3-Day Event for People with Limb Loss/Limb Difference
Salt Lake City, Utah

July 7-9, 2023

Thursday, July 6, 4:00-7:00 pm - Badge and bag pick up
Thursday, July 6, 7:00-9:00 pm - Welcome Reception
Friday, July 7, 8:00 am-8:00 pm
Saturday*, July 8, 8:00 am-8:00 pm
*All Saturday events will be hosted at the National Ability Center
Sunday, July 9, 8:00 am-1:00 pm

Event fee: $50 per person
Event fee includes breakfast and lunch daily and Friday & Saturday night dinner.
Guests can include family members or supportive friends.

Hotel:
Little America Hotel – Salt Lake City
500 S Main St, Salt Lake City, UT 84101

Book your room online no later than Wednesday, June 14 to receive the discounted room rate of $130 per night,including taxes and fees. Or call 800-437-5288 and mention Hanger Clinic's EmpowerFest.

EmpowerYOUth: 1-Day Kid's Day
Saturday, July 8, 2023

Location: National Ability Center
1000 Ability Way, Park City, UT 84060

Schedule:
9 am - 4 pm

For more information, please email EmpowerFest@hanger.com.

Connecting People with Upper and Lower Limb Loss

Registration Type *

(3-Day) Attendee Registration

(1-Day) Kid's Day Registration - must be 17 or younger ($10.00)

Hanger Employee / Speaker

First Name *

Last Name *

Street Address *

Address Line 2

City *

State/Province/Region *

Zip/Postal Code *

Phone Number *

Country *

Gender/Age Group *

Email Address *

T-Shirt Size *

Is this your first time attending EmpowerFest? *

Yes

No

How did you hear about EmpowerFest? *

How did you hear about EmpowerFest?

Are you a person with lower limb loss? *

Yes

No

Please rate your mobility level from 1 to 5 stars: *

1-star: Limited mobility; 5-star: Extremely active

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Are you primarily using a wheelchair for mobility?

Yes

No

Are you bringing an electric wheelchair?

Yes

No

Do you need the hotel to provide a shower chair?

Yes

No

Are you a person with upper limb loss? *

Yes

No

How easy is it for you to use your upper limb prosthesis?

1-star: Extremely difficult; 5-star: Very easy

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Are you a Hanger Clinic patient? * 🛈

Yes

No

Are you bringing a guest? *

Yes

No

Select how many guests you will be bringing and ensure you have filled out the guest information below. (Please note the $10 registration fee covers the child attendee and one parent/guardian. Each additional guest is $10.) * 🛈

Select the box for each guest you will be bringing and make sure you fill out the guest information below. * 🛈

Guest #1 ($50)

Guest #2 ($50)

Guest #3 ($50)

Guest #4 ($50)

Discount Code

Guest Information:

	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #1	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #2	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #3	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #4	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee

Guest Information:

	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #1	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #2	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #3	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #4	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee

Guest Information:

	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #1	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #2	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #3	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #4	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee
Guest #5	First Name	Last Name	City, State	Shirt size	Email	Relationship to attendee

Are you staying at Little America Hotel in Salt Lake City? *

Yes, I am booking my hotel room at Little America Hotel.

No, I will commute to the event.

Are you staying at Little America Hotel in Salt Lake City? *

Yes, I request Hanger event staff to book my hotel room.

Yes, I will book my own hotel room.

No, I will commute to the event.

Arrival Date * +

Departure Date * +

Please select other activities that you are interested in participating in (you may select multiple activities): *

Please select other activities that you are interested in participating in (you may select multiple activities):

Please select other activities that you are interested in learning about (you may select multiple activities): *

The Hanger Foundation is hosting a 1K/5K fun run/walk on Saturday, free of charge for EmpowerFest attendees. All mobility levels are welcome to participate. Please indicate if you are interested in participating and more information will be emailed to you regarding the event. *

Yes, I am interested in participating in the 1K/5K walk/run.

No, I am not interested in participating in the 1K/5K walk/run.

Would you like an assigned run/walk "buddy" to assist and cheer you on your way to the finish line? *

Yes, please

No, thank you

Please fill in the Foundation 1K/5K Participant Information:

	First Name	Last Name	Age	Email
Participant #1	First Name	Last Name	Age	Email
Participant #2	First Name	Last Name	Age	Email
Participant #3	First Name	Last Name	Age	Email
Participant #4	First Name	Last Name	Age	Email
Participant #5	First Name	Last Name	Age	Email

Speaker Code

(Optional) Please share any information about your amputation level and mobility/activity/personal goals that you have for this event.

Additional Requests, Dietary Needs, Comments, or Questions: