Life Member/Chiefs’ In-Service and Annual Conference 2023 Registration

Name:*

First

Last

Department:

Address:

Street Address County City State Postal / Zip Code

E-mail:

Phone Number:

District Number

Are you a STEP Graduate?

Yes

No

Are you a PELC Graduate?

Yes

No

Are you a CLEE Graduate?

Yes

No

Is this your first conference?

Yes

No

Do you plan to stay at the hotel?*

Yes

No

NOTE:

Special Dietary Needs?

LIFE MEMBER REGISTRATION (includes materials, meals, parking and wireless access). Please select:

*Registration Fee includes same room lodging, four meals (Sunday dinner, Monday breakfast and lunch, and Tuesday breakfast), complimentary on-site parking, and free Wi-Fi access.

TOTAL AMOUNT DUE

If Guest/Spouse is attending please note name below:

First

Last

Comments: