Regional Training Conference Registration Form
April 10-11, 2003
Erie County Tactical Task Force
Buffalo, New York
First Name:
M.I.
Last Name:
Suffix
(Jr., Sr., III, etc.)
Organization:
Department:
Work Address:
City:
Province/State:
Postal Code:
Country:
Work Phone:
Home Phone:
Work Fax:
Toll Free #:
E-mail Address :
Home Address:
City:
Province/State:
Postal Code:
Country:
Preferred Mailing Address (please check one):
Work
Home
Comments:
Invoice for:
(up to March 20, after that add $25.00)
$150.00
I am a current member -or- $200.00
I am not currently a member
By submitting this form you are giving authorization for us to invoice your department/agency for this Conference/Membership.
You will receive confirmation of conference registration.