Registration Online registration closes Friday, May 12, 2023, at 5:00 p.m. (CDT).HiddenDate Registration Type(Required) Participant Sponsor Participant TypePlease select one of the following:(Required) School - Student School - Staff/Administrator Professional/Other Speaker Personal InformationName(Required) First Last Title School or Organization(Required) Address(Required) 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 Telephone Number(Required)Email Address(Required) Do you have any dietary restrictions? None Vegetarian Gluten Allergy Lactose Allergy Nut Allergy Shellfish Allergy T‐shirt SizeNOTE: Only the first 150 students to register can receive a t-shirt. Register by April 3 to guarantee your size. Adult S Adult M Adult L Adult XL Adult XXL ADA AccommodationIn compliance with ADA requirements, participants with disabilities can be reasonably accommodated by contacting TTI Event Management & Planning [phone: 979-317-2222] at least five working days prior to the conference. If you have a disability, please specify below. Call to confirm your request prior to the event.Emergency Contact Person(Required) Emergency Contact Telephone Number (the best number for contact)(Required) Sponsor Participation LevelPlease select one of the following Sponsorship levels:(Required) Premier $5,000.00 Gold $2,500.00 Silver $1,500.00 Bronze $500.00 Giveaway $0.00 What do you plan to donate as a Giveaway item?Example donations include e-gift cards, e-coupons, or other giveaways. YTS welcomes any contribution level to help support this event. Registration AcknowledgmentNOTICE: Video/Reproduction/Photo Release(Required)In conjunction with registering for YTS Summit, my "registered party"** and I also grant permission to the Youth Traffic Safety Center Program and the Texas A&M Transportation Institute (collectively "TTI") to take and use visual/audio images of me and my registered party as part of ongoing communications efforts to advance the YTS program. "Visual/audio images" includes any type of recording whatsoever including but not limited to photographs, digital images, drawings, renderings, voices, sound or video recordings, audio clips or accompanying written descriptions. My registered party and I agree that TTI owns the images and all rights related to them. My registered party and I understand that the images may be used in video and audio productions, public service announcements, on the YTS Program website, and any other uses deemed appropriate by TTI, without compensation or notification. My registered party and I waive any right to inspect or approve the finished images or any printed or electronic matter that may be used with them. My registered party and I release and hold harmless TTI, its employees and agents, from any claim, damages, or liability for any violation of any personal or proprietary right my registered party and I may have in connection with such recording or use. My registered party and I freely and voluntarily consent to the use and publication of the images by TTI from this date forward until my registered party and I revoke this consent in writing. If I or any of my registered party are under the age of 18, we confirm that our parents or guardians are aware of these terms and also grants consent to the above stated terms. I have read and agree to the Video/Reproduction/Photo Release statement.** "Registered party" includes registrant's family members and/or school associates accompanying the registrant.Attendance Confirmation(Required)By checking this box, I confirm that I will attend the Youth Transportation Safety Summit. In case plans change, I will let TTI know as soon as possible, so they can make necessary changes. I confirm my attendance. Registration ReviewYou have submitted the following information. Please make sure it is correct before proceeding. {all_fields:nohidden,noadmin} Payment MethodTotal How do you plan to pay?(Required) Check/Money Order (U.S. currency drawn on a U.S. bank) Credit Card Online Payment EM&P only accepts Visa, MasterCard, Discover and American Express credit cards.NOTE: If paying by credit card, your credit card statement will indicate a merchant charge by TTI–Texas A&M Transportation Institute for the amount of your registration fee.HiddenPayment(Required)
