Register for LDACON60 at our Pre-Early Bird Rate! 2023 Early Conference Registration Step 1 of 2 50% Your InformationName* First Last Email* Enter Email Confirm Email Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Which of the following best describes you?*--Choose One--Adult with LDEducatorStudentParent of a Child or Adult with LDProfessionalOther (Please Specify Below)If Other, Please Specify here*Please select the one that best describes how you work in the field...*--Choose One--AdvocateAttorneyCounselorConsultantDoctorLD Service ProviderLobbyistPsychiatristPsychologistSocial WorkerOtherWhat grades do you currently teach?*--Choose One--Early Childhood / Pre-SchoolK-56-910-12Post-SecondaryYour Conference RegistrationIs this your first LDA Conference?*YesNoWhat do you hope to learn by attending?*Where did you hear about this conference?*--Choose One Please--LDA WebsiteEmailSocial MediaReferred by a friend/colleagueOtherIf you chose other above, please specify where.*Choose your attendance option:*--Choose One Please--Full Conference - LDA MemberFull Conference - Non-MemberFull Conference PLUS an Annual MembershipStudent Conference - MemberStudent Conference Non-MemberStudent Conference Plus an Annual Student LDA MembershipSingle Day Only - LDA MemberSingle Day Only - Non-MemberSingle Day Only Plus an Annual LDA MembershipPlease choose your membership affiliate:*--Choose One--AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOutside of the U.S.Illinois has local affiliates, please choose one:*Illinois - No LocalIllinois - Chicago NorthIllinois - Chicago SouthIllinois - Lake Forest/Lake BluffIllinois - NW SuburbanIllinois - Kane KendallIllinois - SW SuburbanIllinois - West CentralIllinois - OrlandMaryland has local affiliates, please choose one:*Maryland - No LocalMaryland - Montgomery CountyMichigan has local affiliates, please choose one:*Michigan - No LocalMichigan - WashtenawNew York has local affiliates, please choose one:*New York - No LocalNew York - Central NYNew York - Long IslandNew York - Western New YorkPlease enter your LDA Member ID here:*Please upload your Proof of Student Status* Drop files here or Accepted file types: jpg, png, pdf. Please note: Only FULL-TIME college students are eligible for the student rate and are required to upload a scan of current student ID AND a copy of your FULL-TIME enrollment, showing your current schedule. Please upload a scan of your current student ID AND a copy of your FULL-TIME enrollment, showing your current schedule in PDF, JPG or PNG format to register.What day are you attending?*Tuesday, February 21, 2023Wednesday, February 22, 2023Thursday, February 23, 2023 Consent* I agree to the terms and conditions as found on the Registration page.Cancellation All cancellations, without exception, must be in writing via email to info@ldaamerica.org. All refunds will be issued within 45 days from request less a $25 administrative fee. No cancellations will be accepted after December 30, 2022. Solicitation LDA does not permit solicitation of any kind during the Conference, except by our sponsors at specified times. Solicitation by any business or person other than exhibitors or sponsors is strictly prohibited. Consent to Record Registration and attendance or participation in the LDA Conference and any affiliated meetings and events constitutes an agreement by the registrant for LDA and its affiliates to use and distribute (both now and in the future) the registrant’s or attendee’s image or voice in photographs, videotapes, electronic reproductions, and audiotapes of such events activities.Were you given a discount code? Enter it here: Total Due: $0.00 How Are you Paying?*--Choose One--Credit CardPurchase OrderUpload Your Purchase Order Here*Please Mail your Check to: LDA Attn: Annual Conference 4068 Mount Royal Boulevard, Suite 224B Allison Park, PA 15101 Please note: If we do not have your check two weeks prior to the event, you will NOT receive access to the conference.Credit Card* Card Details Cardholder Name
