LEADERSHIP SEMINAR: Registration 2024 Leadership Seminar Registration For members to register for the Leadership Seminar This form is to be used by an individual to register themselves and a guest. You can only register one Leadership Seminar attendee per form submission. VERY IMPORTANT REMINDER: ALL WSMTA Leadership Seminar attendees are reimbursed 50% of the WSMTA hotel room rate, regardless of whether they are the first, second or fifth representative from their chapter.Request for reimbursement is done AFTER the Leadership Seminar is finished.Member Name(Required) First Last Designation (NCTM or WSCTM ) Chapter(Required) Leadership Position(Required) Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Phone(Required)Registration FeeThe registration fee is the same for all attendees, regardless of their leadership role or number of chapter representatives. This is new in 2024! Price: Registration Fee(Required)The registration fee is the same for all attendees, regardless of their leadership role or number of chapter representatives. This is new in 2024! In-person registration $65 Virtual (Zoom) registration $35 None Registration Fee(Required) Virtual (Zoom) registration $35 Hotel ReservationRemember to book your room using the WMSTA rate by August 20, 2024. You can also call (509) 454-1111 if you’d prefer to book your room over the phone. If using the link, it is important to edit the length of your stay, as the default might show up as two nights.LUNCH SELECTION(Required)Lunch on Saturday is included with registration. Grilled Vegetable Wrap (GF / Vegetarian) Chicken Caesar Wrap Roast Beef on Ciabatta No Lunch Traveling with a guest?(Required)Will you have a guest (a person not attending the Leadership Seminar) who would like to purchase any meals? No Yes Guest Dinner None DInner $40 Guest Meal Selection & Price Breakfast Lunch Dinner SPECIAL DIETARY NEEDS (if you have none, please indicate "none")(Required)Please list any food allergies, vegetarian requirements or other dietary requests for you (and your guest). Total Please check the subtotal amount before clicking submit. If you do not receive an email confirmation of your registration, please contact WSMTAoffice@gmail.comCredit CardCard Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.