2025 Habitat Midwest Regional Conference Registration We are so excited to have you join us for the 2025 Habitat for Humanity Midwest Conference in April! Please fill out this registration form and we look forward to seeing you in a couple months! Conference Registration(Required)I will be attending the conference (select one): $300 - April 1-3, 2025 (Three Days) $150 - April 1, 2025 (One Day) $150 - April 2, 2025 (One Day) $150 - April 3, 2025 (One Day) Do you have any dietary restrictions?(Required)No RestrictionsGluten FreeVegetarianVeganAllergiesOtherAllergies? Other dietary restrictions? Name(Required) First Last Job Title(Required) Role(Required)Board MemberExecutive DirectorAdministrationConstructionDevelopmentFamily ServicesFinanceMarketingRepairsReStoreTechnologyVolunteerOtherOther Role? Affiliate/Business/Organization Name(Required) Address(Required) Street Address Address Line 2 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 Phone(Required)Email(Required) Enter Email Confirm Email Total Credit CardCard Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.