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2010 Conference Seedling Mile Logo

2010 LHA Conference Registration Form
June 22 – 26 and Post-Conference Tour, June 26 – 27, 2010


Please complete this form and mail it with your check, money order, or credit card information to: Lincoln Highway Association, P.O. Box 1075, Tooele, UT 84074-1075

Name 1
_____________________________Address___________________________________

(Please print your name as you wish it to appear on your conference name badge)

City________________________State________Zip_________

E-mail______________________


Name 2_____________________________Address___________________________________


City________________________State________Zip_________

E-mail______________________


Name 3_____________________________Address___________________________________


City________________________State________Zip_________

E-mail______________________


Name 4_____________________________Address___________________________________


City________________________State________Zip_________

E-mail______________________


Conference Activities and Fees Per Person:

Full Conference Adult
(includes all activities and meals except post-conference):
Regular Registration by May 15
th $240 _______

Late Registration after May 15
th $255 ________

Full Conference Student (K-12 and college, please include copy of student ID):
$150 ________

Must be a member to attend, Non-Members add a one-year membership:
$35 __________





Ala Carte Selections (If not registering for the full conference):

Adult Conference Only
(all activities except bus tours and bus tour meals):
$185 _________


Tuesday Welcome Banquet Only: (including Abe and Mary Todd Lincoln):
$25 __________

West Tour Only (on Wed. or Thurs., includes riverboat lunch & John Deere):
$60 __________

East Tour Only (Wed. or Thurs., includes Phillips Park & Egyptian Theatre):
$50 __________

Thursday Night Meal at Drive-In Only (includes car games and cruise night):
$20 ________

Friday Daytime Speakers Only (includes lunch): $25 __________

Friday Night Awards Banquet Only (includes souvenir mug): $35 __________





Book Room Space in the Loveland Community House:

State Chapter Book Room
(Free): Number of Tables:________ Electric: Yes____ or No____

Book Room (for
private individuals, non-profits, and businesses): $35 per table

Number of Tables:    ________
Electric:     Yes ____ or No ____     Total: _______





Post-Conference (Not Included in Full Conference Fee):

LHA Member Post-Conference Triangle Tour, Saturday and Sunday
(includes Saturday dinner, Sunday lunch is on your own, not included in full conference fee): $25 _______

Non-Member Triangle Tour Only (includes one-year LHA membership): $60 _______

Copy of Traveling the Historic Three guidebook by John and Lenore Weiss (required for those who do not already have a copy, pick up at conference): $12 _______




Grand Total: ____________




Meals
: Please indicate any special dietary restrictions:__________________________________

Disabilities: Please indicate if you have a disability and describe the special accommodations you require to participate fully in this conference:________________________________

Art Work: I plan to submit artwork for the annual art show: Yes _______

Cancellation Policy: Cancellations received by the Association prior to June 6 will be accepted without question. A fee of $25 will be deducted to cover processing. After June 6 there will be no refunds except those granted by the Executive Committee for cases of extreme hardship.

Credit Card Information: Circle One:     Visa     MasterCard     Discover

Name as it appears on card __________________________________

Credit Card Number _________-_________-_________-________ Expiration Date ____-____

Signature______________________________________________

WAIVER OF LIABILITY (must be signed by all registrants) The undersigned hereby agrees that the Lincoln Highway Association and/or its officers and directors shall have no responsibility or liability, in whole or in part, for any loss, damage, or injury to person or property, or any act of omission resulting from, arising out of, or occurring during any activity, program, tour, meeting, meal, or other service and facility furnished or supplied in conjunction with the Annual Lincoln Highway Association Conference.

Signed ______________________________________ Date ___________

Signed ______________________________________ Date ___________

(Guardian's signature is required for those under 18. All attendees must sign the waiver.)

For more information, please e-mail: lincolnhighway2010[at]yahoo.com or call: 815-456-3030 or 815-748-7211 Hotel Information: Page 32 in Fall 2009 Forum and click here.



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