LIA State Exchange - New England Interest Form

Participant Interest Form

Please fill out this form in its entirety.
Space is extremely limited on this trip. The LIA Alumni Activities Committee will select participants for the State Exchange.
LIA Alumni Contact*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Guest Information

First NameLast Name
Guest Email
example@example.com
Guest Phone Number
Format: (000) 000-0000.
Relationship to LIA Alumni
YesNo
Guest Phone Number
Format: (000) 000-0000.
Guest E-mail
example@example.com
Please explain in a couple sentences why you would like to attend this State Exchange:*
Please Note: We will be flying into Boston, MA, on Saturday, September 26th and departing from New York (LaGuardia), NY, on Friday, October 2nd.
YesNo
YesNo
Please do not make travel arrangements until your attendance is confirmed.
Do you have any dietary restrictions or physical limitations that need to be accounted for in the planning of this trip? Please explain in detail:
Pricing:

If you are selected, a non-refundable $500 deposit per participant will be required to hold your spot and will be applied toward the total cost.

Hotel and bussing contracts are still being negotiated. As soon as pricing is finalized, it will be updated on the website.
Are you requesting scholarship assistance from the LIA Foundation?
(Requests for scholarship assistance will be considered by the LIA Board of Trustees). Scholarship Assistance is not guaranteed and is only available to LIA Alumni.
Please click the "Submit" button below to submit your interest.
Should be Empty:

Participant Interest Form