LOADING...
Please wait.
2016 WMTA Conference Registration
ONLINE REGISTRATION FORM
October 21-22, 2016
Radisson Hotel La Crosse
200 Harborview Plaza
La Crosse WI 54601
Membership Status
*Membership Status
I am a current member
I am not a member
General Conference Registration Fees
Active MTNA Member
Early Bird before 9/1/2016
Active MTNA Member
Regular Registration after 9/1/2016
MTNA Collegiate Member
includes meals
MTNA Collegiate Member--VOLUNTEER
Admission to all sessions (no meals)--must volunteer 2 hours
One-day Registration
Specify day for single-day pass:
Specify Day for single-day pass
Friday
Saturday
New MTNA Member
includes meals
Nonmember
includes meals
Conference Events
Friday, October 21, 2016
*Local Association Lunch
11:30am - 1:00pm Box lunch (includes 20% gratuity)
Select Entree*
Orchard Chicken Wrap
Sliced Roast Beef
Dagwood (smoked turkey, ham, pastrami)
Grilled Vegetable Wrap
*District Chairs Lunch
11:30am - 1:00pm Box Lunch (includes 20% gratuity)
*Select Entree
Orchard Chicken Wrap
Sliced Roast Beef
Dagwood (smoked turkey, ham & pastrami)
Grilled Vegetable Wrap
*Friday Evening Banquet
Please select your entree
*Choose Entree
Roasted Chicken Breast
Gorgonzola Stuffed Pork
Spinach Ravioli
Spouse/Guest Banquet
Please select entree (price includes 20% gratuity)
Choose Entree
Roasted Chicken Breast
Gorgonzola Stuffed Pork
Spinach Ravioli
Extra Conference Programs
2016 WMTA Conference Commemorative Programs
*Friday Concert Tickets
Nicholas Roth, recital (one ticket with registration)
Spouse/Guest Concert Tickets
Nicholas Roth, recital
Student Concert Tickets
Nicholas Roth, recital
Saturday, October 22, 2016
Saturday, October 22,2016
Saturday Luncheon
FREE with full registration
Spouse/Guest Luncheon
Luncheon (includes 20% gratuity and tax)
Total
Grand Total:
Personal Information
*E-Mail:
Valid e-mail is required
*First Name:
*Last Name:
*Address Line 1:
Address Line 2:
*City:
*State:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Zip Code:
Date of Birth:
*Phone:
Name on Badge
Company:
Spouse/Guest Name:
Spouse/Guest Name:
Check here if this is your first WMTA Conference
Check here if you are looking for a roommate.
Check here if you are willing to volunteer.
Select day you can volunteer.
Friday
Saturday
Check here if you are a new member.
Check here if you have specific dietary needs for the events you have purchased.
Vegetarian
Vegan
Gluten-Free
Seafood/Shellfish
Dairy
OTHER
Create Your Own Form
using this Template
Want the ability to collect information with an
online form that looks like this one?
Powered by
Elbowspace.com