LIFE Member Registering for Chiefs' In-Service and Annual Conference:
Name:*
Agency:*
Address:
District Number
E-mail:*
Phone Number:
Are you a PELC Graduate?
Are you a CLEE Graduate?
Is this your first conference?
LIEF MEMBER REGISTRATION (includes materials, meals, and breaks only). Please select:
$200 - Guest/Spouse Attending (includes meals & breaks only):
If Guest/Spouse is attending please note name below:
Membership Dues for October 1, 2017 thru September 30, 2018. IF APPLICABLE, please select:
Would you like to receive a hard copy of the conference handouts on-site?
Dietary Needs?
NOTE:
Comments: