Seminar Registration "*" indicates required fields Seminar Attendee InformationName* First Last Email* Cell Phone*Are you a Veteran or 1st Responder?* No Yes - I am a Veteran Yes - I am a 1st Responder Select One of the Following* I will be attending the seminar I am sponsoring someone else Mailing Address* 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 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 13-15, 2023 Part 1 ($100) - Mar 24-26, 2023 Part 1 ($100) - May 19-21, 2023 Part 2 ($250) - Feb 2-5, 2023 (Part 1 must be completed) Part 2 ($250) - Apr 13-16, 2023 (Part 1 must be completed) Part 2 ($250) - Jun 8-11, 2023 (Part 1 must be completed) Part 3 ($175) - Sept 23-25, 2022 (Part 2 must be completed) Part 3 ($175) - Oct 21-23, 2022 (Part 2 must be completed) Part 3 ($175) - Feb 24-26, 2023 (Part 2 must be completed) Part 3 ($175) - Jul 14-16, 2023 (Part 2 must be completed) Seminar Options and Dates (for Veterans & 1st Responders)* Part 1 ($100) - Jan 13-15, 2023 Part 1 ($100) - Mar 24-26, 2023 Part 1 ($100) - May 19-21, 2023 Part 2 ($200) - Feb 2-5, 2023 (Part 1 must be completed) Part 2 ($200) - Apr 13-16, 2023 (Part 1 must be completed) Part 2 ($200) - Jun 8-11, 2023 (Part 1 must be completed) Part 3 ($125) - Sept 23-25, 2022 (Part 2 must be completed) Part 3 ($125) - Oct 21-23, 2022 (Part 2 must be completed) Part 3 ($125) - Feb 24-26, 2023 (Part 2 must be completed) Part 3 ($125) - Jul 14-16, 2023 (Part 2 must be completed) 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 Method*Credit CardPayPal Checkout American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Total PhoneThis field is for validation purposes and should be left unchanged. Δ
