Registration Form - HTA Annual Conference REGISTRATION Please complete the form below. If you prefer to print and email/mail a copy to HTA, please download the form here: click here. Company * Contact First Name * First Contact Last Name * Last Contact Email * Contact Work Phone Contact Cell Phone Registration Authorized By * Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country REGISTRANT(S) Attendee Details Attendee #1 Attendee #1 First First Last Last Attendee #1 Email (optional) to be used to communicate event details. Attendee #2 Attendee #2 First First Last Last Attendee #2 Email (optional) to be used to communicate event details. Attendee #3 Attendee #3 First First Last Last Attendee #3 Email (optional) to be used to communicate event details. Attendee #4 Attendee #4 First First Last Last Attendee #4 Email (optional) to be used to communicate event details. plus1 Add Additional Attendees minus1 Remove Attendees PAYMENT DETAILS Early Registration ends August 8.Regular Registration prices go into effect August 9. September 9 - Golf None SelectedHTA Member - 1 attendeeNon-Member - 1 attendeeHTA Member - 2 attendeesNon-Member - 2 attendeesHTA Member - 3 attendeesNon-Member - 3 attendeesHTA Member - 4 attendeesNon-Member - 4 attendeesHTA Member - 5 attendeesNon-Member - 5 attendeesHTA Member - 6 attendeesNon-Member - 6 attendees Full Registration None SelectedHTA Member - 1 attendeeNon-Member - 1 attendeeHTA Member - 2 attendeesNon-Member - 2 attendeesHTA Member - 3 attendeesNon-Member - 3 attendeesHTA Member - 4 attendeesNon-Member - 4 attendeesHTA Member - 5 attendeesNon-Member - 5 attendeesHTA Member - 6 attendeesNon-Member - 6 attendees Sept 10 - Lunch, Sessions and Dinner | Sept 11 - Lunch, Sessions (either track) and Exhibitors' Night A La Carte: September 10 - Full Day None SelectedHTA Member - 1 attendeeNon-Member - 1 attendeeHTA Member - 2 attendeesNon-Member - 2 attendeesHTA Member - 3 attendeesNon-Member - 3 attendeesHTA Member - 4 attendeesNon-Member - 4 attendeesHTA Member - 5 attendeesNon-Member - 5 attendeesHTA Member - 6 attendeesNon-Member - 6 attendees Sept 10 - Lunch, Sessions and Dinner A La Carte: September 10 - Dinner Only None SelectedHTA Member - 1 attendeeNon-Member - 1 attendeeHTA Member - 2 attendeesNon-Member - 2 attendeesHTA Member - 3 attendeesNon-Member - 3 attendeesHTA Member - 4 attendeesNon-Member - 4 attendeesHTA Member - 5 attendeesNon-Member - 5 attendeesHTA Member - 6 attendeesNon-Member - 6 attendees A La Carte: September 11 - Full Day None SelectedHTA Member - 1 attendeeNon-Member - 1 attendeeHTA Member - 2 attendeesNon-Member - 2 attendeesHTA Member - 3 attendeesNon-Member - 3 attendeesHTA Member - 4 attendeesNon-Member - 4 attendeesHTA Member - 5 attendeesNon-Member - 5 attendeesHTA Member - 6 attendeesNon-Member - 6 attendees Sept 11 - Lunch, Sessions and Exhibitors' Night A La Carte: September 11 - Exhibitors' Night None Selected1 attendee2 attendees3 attendees4 attendees5 attendees6 attendees7 attendees8 attendees Total: Will any of your attendees be attending the Supervisor & Operations Manager Track on Thurs, Sept 11?? Yes, which ones?Yes, which ones? No How do you plan to pay? Payment via Check (payable to "Hawaii Transportation Association", mailed to: P.O. Box 30166, Honolulu, HI 96820). Payment via Credit Card (2% surcharge will be assessed). Please bill my company, we are an HTA member in good financial standing. Thank you for Registering. Please fill out the form below if you would like to have us charge you via credit card. Name of Cardholder (as it appears on the card): * Email Address for Receipt: * After payment is processed by HTA, a receipt will be emailed to this email address. Billing Address of Cardholder: * Billing City/State/Zip: * Please note the class, event, invoice #, etc. for this payment: * Card type: * Master Card Visa American Express Amount of transaction authorized ($): * Do not include the 2% surcharge, this will be automatically calculated and added by HTA. Credit Card Number: * Expiration (MM/YYYY): * 3 or 4-digit CVC Code: * Phone (XXX-XXX-XXXX) * Signature (By writing out your full name below, you agree to the amount of this transaction and authorize HTA to charge the total to the credit card provided above): * Special Requests Payment notes, food allergies, questions? PHOTO/VIDEO RELEASE: By attending this event, I consent to the use of any photo or video taken of me for promotional or educational purposes. I understand that these materials may be used in print, online, or in other media by the organization. Attendees may opt out by notifying the check-in staff at the event. Submit If you are human, leave this field blank.
