Registration Form - General Membership Meeting 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 * Name * First Last * Last Email * Work Phone Cell Phone REGISTRANTS Registrant #1 Registrant #1 First First Last Last Registrant #2 Registrant #2 First First Last Last Registrant #3 Registrant #3 First First Last Last Registrant #4 Registrant #4 First First Last Last Registrant #5 Registrant #5 First First Last Last plus1 Add Additional Registrants minus1 Remove Registrants PAYMENT DETAILS Mail cash or checks payable to Hawaii Transportation Association to P.O. Box 30166, Honolulu, HI 96820. For credit card payments, use the credit card authorization form below. Number of Registrants ($100/member) 1 Registrant2 Registrants3 Registrants4 Registrants5 RegistrantsNone Number of Registrants ($125/non-member) None1 Registrant2 Registrants3 Registrants4 Registrants5 Registrants Total: How do you plan to pay? Credit Card (2% credit card processing fee will be added) Business Check Cash Thank you for Registering. Please fill out the form below if you would like to have us charge you via credit card. Name of Cardholder (as it appears on the card): * Email Address for Receipt: * After payment is processed by HTA, a receipt will be emailed to this email address. Billing Address of Cardholder: * Billing City/State/Zip: * Please note the class, event, invoice #, etc. for this payment: * Card type: * Master Card Visa American Express Amount of transaction authorized ($): * 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): * Submit If you are human, leave this field blank.
