Chiefs’ In-Service and Annual Conference 2023 Registration

Registering for CIS/AC 2023

Name:

First

Last

Title:

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 overnight at the hotel?

Yes

No

Note:

Special Dietary Needs?

REGISTRATION (includes lodging, meals & breaks). Please select your preference(s):

$700 Member - received BEFORE 4/1/23

$725 Member - received AFTER after 4/1/23

$750 Non-Member - received BEFORE 4/1/23

$775 Non-Member - received AFTER 4/1/23

Textarea

Membership Dues for October 1, 2023 thru September 30, 2024. IF APPLICABLE, please select one option:

$200 - Guest/Spouse (includes same room lodging meals & breaks only) - invoiced separately

Yes

No

If Guest/Spouse is attending please note name below:

First

Last

TOTAL AMOUNT DUE

Comments: