2019 West Regional Conference GROUP REGISTRATION Form
Please complete this form if you have a group of 4 or more individuals who would like to attend the West Regional Conference, Nov. 15-17, 2019, in Las Vegas.

GROUP REGISTRATION IS FOR US LACROSSE MEMBERS ONLY

Early-Bird Rate (8/12-9/23): $60.00
Regular Rate (9/24-11/7): $70.00

ALL registrants on the form MUST be current US Lacrosse members. Please have ALL US Lacrosse member numbers prior to submitting this form.

If you have more than four (4) people in the group, please submit a second form.

Group Registration closes at 11:59PM EST on November 7th.
GROUP CAPTAIN INFO
The Group Captain will be the main point of contact for this group registration and will be contacted to submit the final payment.
Group Captain First Name *
Your answer
Group Captain Last Name *
Your answer
Group Captain USL Membership # *
Your answer
Group Captain Email *
Your answer
Group Captain Phone # *
Your answer
ADDITIONAL MEMBER #1
Additional Member #1 First Name *
Your answer
Additional Member #1 Last Name *
Your answer
Additional Member #1 USL Member # *
Your answer
Additional Member #1 Email
Your answer
ADDITIONAL MEMBER #2
Additional Member #2 First Name *
Your answer
Additional Member #2 Last Name *
Your answer
Additional Member #2 USL Member # *
Your answer
Additional Member #2 Email
Your answer
ADDITIONAL MEMBER #3
Additional Member #3 First Name *
Your answer
Additional Member #3 Last Name *
Your answer
Additional Member #3 USL Member # *
Your answer
Additional Member #3 Email
Your answer
ADDITIONAL MEMBER #4
Additional Member #4 First Name
Your answer
Additional Member #4 Last Name
Your answer
Additional Member #4 USL Member #
Your answer
Additional Member #4 Email
Your answer
Submit
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