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IL 2012 Instate Training Registration Form

Thank you for volunteering to participate in the LWV Membership and Leadership Development (MLD) Program and for planning to attend the LWV Instate Training in Joliet, IL. The training will take place at the Holiday Inn Joliet Banquet and Conference Center from 1pm on Saturday, September 8 until Noon on Sunday, September 9, 2012. Please complete this registration form once you have made your travel arrangements to confirm your attendance. (If you need to fly to this training, you MUST contact Sara Sanders at SSanders@lwv.org BEFORE booking to ensure full reimbursement. LWVUS may not completely reimburse your flight if you do not confirm your travel plans BEFORE booking.) PLEASE COMPLETE THIS FORM BY WEDNESDAY, AUGUST 22, 2012. IF YOU HAVE ANY QUESTIONS, CONTACT SARA SANDERS AT SSANDERS@LWV.ORG.

1. Please provide your information below.

First Name: *This question is required.

Last Name: *This question is required.

Your Local League:

Your State: *This question is required.

Email Address: *This question is required.

Phone Number (Preferred, Daytime): *This question is required.

Mobile Phone:

2. Please indicate the mode of transportation you'll be taking to the training. *This question is required.

Please enter an 'other' value for this selection.

3. If traveling by plane or train, please let us know your arrival information:

Flight/Train Number:
Arrival Date:
Arrival Time (CST):
Arrival Airport/Station:

4. If traveling by plane or train, please let us know your departure information:

Flight/Train Number:
Departure Date:
Departure Time (CST):
Departure Airport/Station:

5. To manage costs and allow for bonding among participants, you will share a sleeping room with another participant unless otherwise stated. If you choose to have your own sleeping room, you will be expected to pay the difference ($41 plus taxes per night). Please choose your preference. *This question is required.

6. Do you have any special dietary needs? *This question is required.

Please enter an 'other' value for this selection.

7. Is there any additional information regarding your travel/visit that you think we should know? *This question is required.

Please enter an 'other' value for this selection.

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