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 16. Regular Registration prices go into effect August 17. September 10 - 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 11 - Lunch, Sessions and Dinner | Sept 12 - Lunch, Sessions and Exhibitors Night 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 Dinner A La Carte: September 11 - 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 12 - 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 12 - Lunch, Sessions and Exhibitors Night 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 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? Submit If you are human, leave this field blank.
