On Site Registration "*" indicates required fields 1Basic Info2Supplemental Info3Demographic Questions4Conference Fees5Additional Items6Review7Payment Hotel CodeToday's Date MM slash DD slash YYYY Personal InformationPlease fill out this form under the HOH (Head of Household’s) name. For LPA purposes, the HOH is the person with dwarfism in your family. In a multiple-LP household, the oldest LP in the household is usually the HOH. HOH is the person to whom this conference book was addressed.Each member will go through the form, completing the online registration for the LPA HOH member. Then after the initial payment, you will have access to add all your activities, banquet selections, and add additional family members and guests to your registration.Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Password* Enter Password Confirm Password Strength indicator Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age at Conference*GenderGenderMaleFemaleNon-binaryTransgenderMy gender is not listedPrefer not to answerPreferred Pronouns: DiagnosisAchondroplasiaAverage HeightCartilage Hair Hypoplasia (CHH)Diastrophic DysplasiaHypochondroplasiaMultiple Epiphyseal Dysplasia (MED)Morquio / MPSMOPDOsteogenesis Imperfecta (OI)PseudoachondroplasiaSED / KniestUndiagnosed / UnknownOther Supplemental InformationIs this your first National Conference? Yes No Do you only or primarily speak Spanish? Yes No Do you only speak a language other than English? Yes No Other Language Are you flying or driving to the conference? Flying Driving Other Other transportaion Where will you be staying during the conference? Marriott Relatives / Friends My Home Other Hotel Other Hotel Emergency Contact Name* Emergency Contact Phone*Transportation NeedsIt is imperative that you indicate transportation needs when you register, if you will be going on one or more off-site events or tours. Please be sure to indicate if you or anyone in your party use a wheelchair, scooter, collapsible scooter, cane or crutches. Please also indicate whether you are able to transfer from your wheelchair or scooter. Providing accessible transportation for events is contingent upon you indicating your needs on the registration form. The reason LPA asks for more information regarding accessibility needs is to ensure the correct type of transportation will be provided; your information will not be shared otherwise. Failure to provide this information will result in limited accessible transportation.Can you and your party member(s) walk up and down steps if necessary? Yes No Will you, or anyone in your party be in a wheelchair or a scooter? Yes No If so, how many?What are their names?First NameLast Name Add RemoveCan you and your party member(s) transfer out of a scooter or wheelchair if needed? Yes No Do you have any other access needs that we should be aware of? (i.e. ASL interpretation, captioning, language translation, braille materials, etc.) Yes No Other Access Needs Inclusion InformationThe following section is intended to help us learn about the various identities and backgrounds that make up our conference attendees. The questions may be sensitive to some, but your survey responses are anonymous and optional. LPA will only use the aggregate data in its analysis and planning. Providing us with this information will help us plan events more effectively and work towards increased inclusivity.Would you be willing to answer 3 demographic questions? Yes No Does anyone in your household identify as having any of the following disabilities (please check all that may apply Intellectual or Developmental Disability Blind or Low Vision Deaf or Hard of Hearing Wheelchair, walker or mobility device user Autism Spectrum Disorder Chronic Pain and/or disease Learning Disability Other Other Household disablity What race/ethnicity best describes all members of your household attending this year’s conference (check all that may apply) White Black / African American / Caribbean Hispanic / Latinx Asian / Asian American Native American / Alaskan Native / Indigenous Native Hawaiian / Pacific Islander / Samoan Does anyone in your household attending this year’s conference receive public assistance benefits such as Social Security Income, Social Security Disability Income, Medicare, Medicaid, General Assistance, etc.? Yes No I’m not sure Prefer not to say Everyone attending the LPA National Conference must be registered and receive a Conference registration badge to be worn at all events. Non-registered individuals may be removed from the conference and the hotel.Nightly dances, all workshops, receptions, medical meetings, Fashion Show, Talent Show, Bingo and the Barty Lounge are included in the price of registration. Early Registration: Before May 2 Late Registration: May 2 – June 1 After June 1 and Onsite Current Annual Member $160.00 $180.00 $200.00 Lifetime Member $140.00 $160.00 $180.00 International Member/ Senior (Age 60+) or College Student $140.00 $160.00 $180.00 Non-Member $220.00 $240.00 $260.00 Membership Registration Fees Current Annual Member Lifetime Member Medical Registration Non-Member International Member / Senior(Age 60 and up) or College Student Household Members Name Total Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Child Registration Name of Child Total Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Guest Registration Guest Name Total Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. LPA Banquet Dinner Choices Dinner Choice Quantity Total Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Offsite and Pre-Paid Events Email Total Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Review Details{all_fields:nohidden} PaymentSubTotal $0.00 Total Costs Price: $0.00 Coupon Total HiddenTotalConditionalCredit CardCard Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.
