SpringRegionalForm

District 4 Spring Regional Registration

May 3-5, 2019 - Fort Myers, FL

Late/Onsite Registration is after April 23!

LPA Members - List your HOH (Head Of Household) first. The HOH is the person the LPA membership is listed under. Ex: The person that the LPA Today and Conference Book is addressed to. Then list additional household members and guests.

Inactive/Non-Members - List your HOH (Head Of Household) first. Then list additional household members and guests.

HOH Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Area CodePhone Number

E-mail Address*

Yes

Drury InnHoliday Inn(Overflow hotel)Home - I live local

First/Last Names of additional household members and guests:*

Total # of people attending?*

YesMaybeNo, I'm arriving on Saturday.

Kids Room: First/Last Name & Age of each child

Ages 2-12 years old

LPA Member: Single $40LPA Member: Couple/Family $55Inactive/Non-Members: Single $40 + LPA Membership FeeInactive/Non-Members: Couple/Family $55 + LPA Membership Fee

Additional Guests - $10 per person

'Guests' are relatives or friends not living in the same household. Ages 3 and under Free.

Saturday Luncheon - Adults $15 each

Olive Garden Buffet

Saturday Luncheon - Kids 4-12 yrs old $8 each

Olive Garden Buffet

Saturday Luncheon - Under 3 yrs old *Free*

Olive Garden Buffet

Registration & Event Fees Total $*

Add your Registration Fee & Luncheon

Volunteer Sign Up: Volunteers are always needed and appreciated! If you would like to volunteer, please check any of the following spots below that may interest you.

Saturday: RegistrationSaturday: Kids RoomSaturday: Boccia Ball

LPA Code of Conduct Acknowledgement:*

Remember your total $ amount from above. After submitting this form please make your payment. Thank you!