LAP Conference Attendee Registration

Complete this form, submit, and follow the link to the payment page.

Registration Type  Choose One:	(Choose one from the drop down listActive LAP member (LAP-C Certified)Active LAP Member (Not Certified)Retired LAP Member (LAP-C Certified)Retired LAP Member (Not Certified)All Other Registrants
Payment Method:	(Choose one from the drop down list)Credit CardMailed Check or Money OrderLAP or Chapter ScholarshipIAFF Chicago FirefightersAuthorized UAW FordAuthorized UAW ChryslerAuthorized CWA-HorizonComp-No Fee
Last Name:
First Name:
Middle Initial (optional):
Email Address:
Union Member Status:	(Choose one from the drop down List)Union MemberNot a Union Member
Name of Union/Local #:
Are You a LAP Member:	Yes   No
If Yes, Which LAP Chapter?	CaliforniaCarolinaColoradoConnecticutFloridaDetroitMassachusettsMidwestNorthern CaliforniaTexasNew York CityPhiladelphiaRhode IslandSouthwestTennesseeTri-StateWashington DCWestern New York(Choose one from the drop down list)
Employer:
Contact Phone #:
Mailing Street Address:
City:
State/Provine:
Zip Code:
Comment: