Conference Registration "*" indicates required fields EmailThis field is for validation purposes and should be left unchanged.Name* First Last Email* Phone*Affiliation*Address* Street Address Address Line 2 City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code LMCA ConferenceProduct NameOption $20, Student Registration $185, Early bird registration (Includes cost of t-shirt. Select t-shirt size below) $235, Late registration, Nov 13th – Dec 11th (A limited number of t-shirts will be available for on-site registration) $30, Guest for Pre-Banquet Social & Banquet $50, Join the LMCA $50, LMCA Annual Membership Renewal $0, Hathaway Ritter Distinguished Achievement Award Recipient and Spouse T-Shirt sizeSmallMediumLargeXLarge2XLarge3XLargePayment Options* Credit Card Check or money orderMail to: LMCA Registration: Louisiana Mosquito Control Association, 611 Old Central Taxiway, New Iberia, LA 70560 My registration is included in my sponsorship/vendor package Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Total Acknowledge LMCA Bylaws & Policy for Professional Behavior I have read LMCA Bylaws & Policy for Professional BehaviorView Bylaws (PDF) View Policy for Professional Behavior (PDF) Upcoming EventsLatest Newsletter(opens in new tab)Interactive Map
