Registration Form
Event Details
Event Name
Location
Start Date
Start Time
Event Fee
$
Please log into the
LTC Account Portal
to register for this event.
Unfortunately the capacity for this event has been reached
. At this time we are
not
accepting registrations for our waitlist.
Unfortunately the capacity for this event has been reached
. At this time we are accepting registrations for our waitlist. Complete the form below to be added to our waitlist, and we will contact you if a spot opens up.
This event has been canceled.
Please contact events@ltcillinois.org with questions.
Registration is closed.
Organization
To change your organization, please visit the LTC Account Portal at ltcillinois.org/account.
Contact Details
First Name
Last Name
Phone Number
Email
To change your organization, please visit the LTC Account Portal at ltcillinois.org/account.
x
Job Title
IEIN Number
Billing
Billing
Please select...
Invoice my Organization
Invoice Me
Pay with Credit Card
Please provide your home address.
Please provide your district billing address.
Billing Contact Name
Billing Contact Email
Address
City
State
Zip
Cardholder Full Name (First and Last)
Cardholder Email Address
Credit Card Number
Expiration Date Month
Expiration Date Year
CVV
Additional Details
Cancelation/Refund Policy.
I acknowledge that all cancelation requests must be made in writing and sent to events@ltcillinois.org. A 100% refund will be granted when the cancellation request is received at least 24 hours before the event. Attendees who pay with credit cards will be refunded the full amount minus a 3% processing fee. No refund will be granted if the request is received less than 24 hours in advance. If LTC cancels the event, attendees that paid with credit card will receive a 100% full refund.
EventID
ContactID
AccountId
Default Email Validation Text
Conditional Picker
Please select...
a
b
c
Registration Cost
Please select...
free
paid
Target Audience
Please select...
Parent
Other
LTC Event Website Confirmation Page
Event Status