Annual Conference Registration Form

REGISTRATION

Please complete the form below.

Company

Contact First Name *

First

Contact Last Name *

Last

Contact Email *

Contact Work Phone

Contact Cell Phone

Registration Authorized By

Address

City

State/Province

Zip/Postal

Country

September 15 - Golf Tournament Sponsors & Registration

Epic Package: $40/ Golfer includes Closest to the Pin & Longest Drive

Closest to the Pin - $20/ player

Longest Drive - $10/golfer

Mulligan - $20 for 2 mulligans (2 max per player)

Golfer #1

First

Last

Golfer #1 Handicap

Golfer #2

First

Last

Golfer #2 Handicap

Golfer #3

First

Last

Golfer #3 Handicap

Golfer #4

First

Last

Golfer #4 Handicap

Annual General Membership Sponsorship Opportunities

Exhibitors Night/ Tradeshow Sponsorship

Full Registration - $475/ HTA Hawaii Member | $575/ NON HTA Hawaii Member

Sept 16 - Lunch, Sessions and Dinner | Sept 17 - Lunch, Sessions (either track) and Exhibitors' Night

A La Carte: September 16 (FULL DAY) - $350/ HTA Hawaii Member | $400/ NON HTA Hawaii Member

Sept 16 - Lunch, Sessions and Dinner

A La Carte: September 16 (LUNCH ONLY) - $100/ HTA Hawaii Member | $125/ NON HTA Hawaii Member

A La Carte: September 16 (Dinner Only) - $225/ HTA Hawaii Member | $275/ NON HTA Hawaii Member

A La Carte: September 17 (FULL DAY) - $350/ HTA Hawaii Member| $400/ NON HTA Hawaii Member

Sept 17 - Lunch, Sessions and Exhibitors' Night

A La Carte: September 17 (LUNCH ONLY) - $125/ HTA Hawaii Member | $150/ NON HTA Hawaii Member

A La Carte: September 17 (EXHIBITORS NIGHT) - $50/person

REGISTRANT(S)

Attendee Details

Attendee #1

First

Last

Attendee #1

First

Last

Attendee #1 Email

(optional) to be used to communicate event details.

Select the Appropriate Track

Supervisor

Operations

Attendee #2

First

Last

Attendee #2 Email

(optional) to be used to communicate event details.

Select the Appropriate Track

Supervisor

Operations

Attendee #3

First

Last

Attendee #3 Email

(optional) to be used to communicate event details.

Select the Appropriate Track

Supervisor

Operations

Attendee #4

First

Last

Attendee #4 Email

(optional) to be used to communicate event details.

Select the Appropriate Track

Supervisor

Operations

Add Additional Attendees Remove Attendees

Total:

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 3% 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.

REGISTRATION

REGISTRANT(S)

Attendee Details

Thank you for Registering. Please fill out the form below if you would like to have us charge you via credit card.

PHOTO/VIDEO RELEASE:

Section