LTC Registration Form

Please complete the registration form below. To see full event details, search for the LTC event profile page at ltcillinois.org/events. Questions regarding registration can be directed to events@ltcillinois.org.

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.

Event Details

Event Name

Location

Start Date

Start Time

Event Fee

Organization

Type of Organization

Illinois Education Organization (i.e., school district, private school, ROE/ISC, association, etc.)Non-Illinois Education OrganizationVendorIndependently Employed or Retired

Select Your Organization

If your institution is not listed, it may be included under a different name. To request an Illinois organization be added to the list, please email support@ltcillinois.org.

Name of Vendor or Non-Illinois Organization

Address

City

State

Zip

Contact Details

First Name

Last Name

Phone Number

** ReType Email

Job Title

Primary Performance Responsibility

IEIN Number

Billing

Please provide your home address.

Please provide your district billing address.

Billing Contact Name

Billing Contact Email

Address

City

State

Zip

Additional Details

I acknowledge that failure to cancel at least 24 hours prior to the event may result in being invoiced. Any “no shows” will be invoiced.

If you are unable to attend the event after registration, please let us know in advance.

I would like to sign up for the LTC newsletter.

EventID

Email Doesn't Match Message

Success

Default Email Validation Text

Conditional Picker

Registration Cost

Target Audience

Account - Assigned for Manual Review

Account - Independent/Retired

Account - Illinois Org ID

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