Mid-Atlantic LGBTQA Conference - Group Registration

To reduce confusion and streamline communication, we require groups who intend to pay together to designate two contact persons that will be held responsible for arranging payment for all attendees in their group. If you are not an officer or advisor for your group, please ask them to complete this form.

The primary contact will be notified via email each time an individual registers as a member of the group.
It is the group leader's responsibility to arrange conference fee payment for all members of the group.
If a group leader receives notification of registration for an individual that is not part of their group, they must contact the LGBTQA Resource Center before Friday, October 22, 2023.
At least one of the group leaders should be a faculty/staff advisor to the organization.
At least one of the group leaders MUST attend the conference.

Group Registration Form:

Name of Institution *

Please enter the name of your College/University or Non-Profit Organization.

Name of Club/Organization *

Please enter the name of your College/University sanctioned organization.

Payment Method *

Credit Card (Strongly Recommended)

Check delivered via USPS by November 1

Check provided at registration desk upon arrival

Check delivered via USPS by December 1

Estimated Attendees *

If possible, please provide an estimate of the total number of individuals in your group.

Please enter name and contact information for Primary Contact person.

First Name *

Last Name *

Email Address *

Phone Number *

Primary contact will attend conference *

Please enter name and contact information for Secondary Contact person.

First Name *

Last Name *

Email Address *

Phone Number *

Secondary contact will attend conference *