Seminar Registration (2023 Pricing) "*" indicates required fields Seminar Attendee InformationName of Seminar Attendee* First Last Email* Cell Phone*Mailing Address of Attendee* Street Address City State AlabamaAlaskaAmerican 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 Are you (the Attendee) a Veteran or 1st Responder?* No Yes - I am a Veteran or 1st Responder Select One of the Following* I will be attending the seminar I am sponsoring someone else Seminar InformationPLEASE NOTE: Due to the experiential nature of The Road Adventure, social distancing is not possible during your experience. By choosing to begin, continue, and conclude your experience at The Road Adventure you understand and accept that social distancing is not possible and that you agree to assume and accept all risks and liabilities accordingly. Masks are optional.Seminar Options and Dates* Part 1 ($100) - Jan 5-7, 2024 Part 1 ($100) - Mar 1-3, 2024 Part 1 ($100) - Jun 7-9, 2024 Part 1 ($100) - Sep 6-8, 2024 Part 2 ($250) - Jan 18-21, 2024 (Part 1 must be completed) Part 2 ($250) - Mar 14-17, 2024 (Part 1 must be completed) Part 2 ($250) - Jun 20-23, 2024 (Part 1 must be completed) Part 2 ($250) - Sep 19-22, 2024 (Part 1 must be completed) Part 3 ($175) - Feb 2-4, 2024 (Part 2 must be completed) Part 3 ($175) - Apr 5-7, 2024 (Part 2 must be completed) Part 3 ($175) - Jul 19-21, 2024 (Part 2 must be completed) Part 3 ($175) - Oct 25-27, 2024 (Part 2 must be completed) Seminar Options and Dates (for Veterans & 1st Responders)* Part 1 ($100) - Jan 5-7, 2024 Part 1 ($100) - Mar 1-3, 2024 Part 1 ($100) - Jun 7-9, 2024 Part 1 ($100) - Sep 6-8, 2024 Part 2 ($200) - Jan 18-21, 2024 (Part 1 must be completed) Part 2 ($200) - Mar 14-17, 2024 (Part 1 must be completed) Part 2 ($200) - Jun 20-23, 2024 (Part 1 must be completed) Part 2 ($200) - Sep 19-22, 2024 (Part 1 must be completed) Part 3 ($125) - Feb 2-4, 2024 (Part 2 must be completed) Part 3 ($125) - Apr 5-7, 2024 (Part 2 must be completed) Part 3 ($125) - Jul 19-21, 2024 (Part 2 must be completed) Part 3 ($125) - Oct 25-27, 2024 (Part 2 must be completed) Have you (or attendee if you are sponsoring) previously attended The Road Adventure? No Yes Approximately what year did you attend?* What program part(s) did you attend?* Note: All registrations must be completed and a non-refundable down-payment paid in full 10 days prior to the start of the Part 1 Adventure you wish to attend. Sponsor Information (If Applicable)If you are sponsoring and wish to personally register and pay for someone else’s Road experience, IT IS EXPECTED that the person you are sponsoring is aware of the fact that you are sponsoring/registering them and that The Road Adventure office will be contacting them to welcome them and confirm their registration.Name of Sponsor (If Applicable) First Last Sponsor's email address Sponsor Phone (Contact Number)Payment SectionPayment Method*Credit CardPayPal Checkout American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Total EmailThis field is for validation purposes and should be left unchanged. Δ
