This event has only 300 space(s) left. If you continue and register more than 300 people (including yourself ), the whole group will be wait listed. Or, you can reduce the number of people you are registering to 300 to avoid being put on the waiting list. Thank you for registering the Long Island Natural History Conference. Contact Info First Name * Last Name * Organization Name Phone * Email * Street Address * Supplemental Address 1 City * State * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Country - select Country - United States Canada Registration * Nonprofit Partner (includes 2 tickets & opportunity to table at the conference) - $ 250.00 Nonprofit Partner (includes 4 tickets & opportunity to table at the conference) - $ 500.00 Total Authorize.net (Credit Card) Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 Warning: Undefined array key "ccid" in /home/u193978372/domains/seatuck.org/public_html/wp-content/uploads/civicrm/templates_c/en_US/31/89/3e/31893e6117912fac970609d66cdfe5f26ac3469a_0.file.BillingBlock.tpl.php on line 112 Warning: Attempt to read property "value" on null in /home/u193978372/domains/seatuck.org/public_html/wp-content/uploads/civicrm/templates_c/en_US/31/89/3e/31893e6117912fac970609d66cdfe5f26ac3469a_0.file.BillingBlock.tpl.php on line 112 My billing address is the same as above Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - United States Canada State/Province * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Review
