Registration Destination Statehouse Registration 1 Contact Info2 Tickets & Sponsorship3 Pay Name* First Last Company / Organization*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Sponsorship Level*Please include yourself in the list of attendees if you are sponsoring and attending.NoneEvent Sponsor ($600)Destination Statehouse Sponsor ($300)Legislative Evening Sponsor ($400)Logo Upload (optional)Or email your logo to email@example.comAccepted file types: jpg, gif, png, jpeg, pdf.Day Event TicketsLunch is included in Destination Statehouse activities. Price: $35.00 Quantity: Evening Event Tickets Price: $50.00 Quantity: Total $0.00 Would you like to attend the Statehouse tour?*YesNoDay Attendee 1 Name*Day Attendee 1 Email* Day Attendee 2 NameDay Attendee 2 Email Evening Attendee 1 Name*Evening Attendee 1 Email* Evening Attendee 2 NameEvening Attendee 2 Email Evening Attendee 3 NameEvening Attendee 3 Email Evening Attendee 4 NameEvening Attendee 4 Email Evening Attendee 5 NameEvening Attendee 5 Email Please list any dietary restrictions. (optional)Legislators (optional)List the name(s) of your legislators if you would like contact information in order to make an appointmentName Would you like to donate $5 to the scholarship fund?*Sure!No ThanksPay by Credit Card or Check?*Credit CardCheckCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Please mail your check to: Travel Industry Association of Kansas825 South Kansas Ave. Suite 502 Topeka KS, 66612 Total $0.00 NameThis field is for validation purposes and should be left unchanged.