Registration Information

First Name: (* Required Field)

Last Name: (* Required Field)

Select Male or Female:

Male Female

LISTA Chapter Member Affiliation:  Your current Membership Status will be verified one week prior to the conference. 
If you are not a member you will be charged the non Member fee

California Mid Atlantic Potomac New York Florida North Texas West Texas New England Non Member

Line of Business:  

Airfone Corporate Finance Enterprise Solutions Human Resources Information Svcs (Directories) Information Technology International Legal and Regulatory Network Services Group Performance Assurance Public Affairs and Comm Retail Markets Strategy and Development Telcom Finance Telecom Process Assurance Wholesale Markets Wireless Not Applicable

Work Address:(* Required Field)

Floor or Room Number: (* Required Field)

City:(* Required Field)

State:(* Required Field)

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip code:(* Required Field)

Home Address:

City:

State:

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip code:

Email Address : (* Required Field)

Work Telephone:  (* Required Field)

Home Telephone:

Emergency Contact:

Emergency Contact Relationship:

Emergency Contact Phone:

Special Needs:

Dietary Needs:

Vegetarian Gluten Diet Only Vegan