2019 Conference Registration

Smoky Hill Trail Conference Registration
October 18 -20, 2019
Fort Wallace, Kansas

Registration Deadline: October 1, 2019

  1. Personal Information

            First and Last Name (s)________________________________________             Address __________________________________________________
            City ___________________________ State ____ Zip _______________
            Telephone __________________Email___________________________

2,         Miscellaneous Information

           Please check here if you are interested in serving as a:  ____ Board Member,
            Committee Member: Membership ____, Nominating ____, Awards ____,
            Conference      Planning ____, Budget/Finance ____, National Historic Trails
            ____, Historic            Preservation ____, Public Relations ____
            Special diet requirements (i.e., vegetarian, food allergies) __________________
            Do you have access to our website:  _____ Yes   _____ No

3,        Conference Fees

           Registration (includes Saturday lunch): Member, OR # attending ___@ $40                                                                           Non-member***     # attending ___ @ $65

            Friday bus tour, sack lunch (must be registered)          # attending ___ @ $25

            Saturday banquet, general membership meeting          # attending ___ @ $18

                                                                                Total Registration Fees: $______    

            *Non-member registration includes individual membership through 2020 and
              other family members living at that same address may register at the member
              rate.

  1. Membership fees

           NOTE:  All annual memberships are calendar year.  Your new
           membership or renewal at this time will cover your membership
           through December 31, 2020

            Membership categories (Existing membership expire 12/31/2019)

            ___$25 Individual  ___$50 Business     ___$30 Family (lives at same address)

            ___$100 Patron       ___$40 Institution (Libraries, Museums, Historical Societies)

            ___$500 Lifetime                                                   _____ New      _____ Renewal

                                                                                      Total Membership Fee $ ______                                                                                   Total submitted              $______

  1. Payment Options:

            Credit Card – Please use the PayPal button on the right, select the items for you,
            then  click  “Add to Cart”.

           Personal Check – Please mail form and payment to:
           Smoky Hill Trail Association, P.O. Box 978, Hays, KS 67601  
 

By submitting this registration form I (we) understand and agree that SHTA and its officers and agents are not responsible or liable for any accidents or injury that occur during the 2019 Smoky Hill Trail Association Conference and related activities. I (we) waive and release any such claim(s).