Please fill in, and send the form below to the LTIA Registrar to register for the LTIA National Conference June 10-17, 2017 in Washington, DC.

For questions that do not apply to you, please enter ‘not applicable’.

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Deposit and tuition for seven days of lodging, meals, special speakers, tours, and notebook in DC is only $399 total. Payment dates will be sent to you with registration confirmation.

 

Date of LTIA Conference (required)

Your First Name (required)

Your Middle Name (optional)

Your Last Name (required)

Preferred name on nametag (optional)

Home Address (Required)

Home City (Required)

Home State (Required)

Home Zip (Required)

Home Country (Required)

Home Phone (Required)

Mobile #(Required)

Your Email (required)

Student, Advanced, Intern, Chaperone? (Required)
StudentAdvancedInternChaperone

Gender (Required)
MaleFemale

Age (Required)

Birth date (Required)

Birth city (Required only if you want to tour the White House and Pentagon)

Birth state (Required only if you want to tour the White House and Pentagon)

Birth country (Required only if you want to tour the White House and Pentagon)

SSN (Required only if you want to tour the White House and Pentagon)

Church (Required)

Church address (Required)

Church phone (Required)

Pastor name (Required)

Pastor phone (Required)

Pastor address (Required)

Parent name (Required)

Parent phone (Required)

Spouse (Optional)

Emergency contact name (Required)

Emergency contact phone (Required)

Previous attendance years (Required)

School name (Required)

Highest School year (Optional)

Arrival Date (Optional)

Transportation (Vehicle / Airplane)? (Required)
AirplaneVehicleOther

Flight arrival time (Optional)

Airport Name arrival (Optional)

Airline Name arrival (Optional)

Flight # arrival (Optional)

Depature date (Optional)

Flight depart time (Optional)

Airport Name departing (Optional)

Airline Name departing (Optional)

Flight # departing (Optional)

Referred by (Optional)

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