Regional Training Conference Registration Form
April 24 - 25, 2003
Topeka Police Department
and
The Washburn University Criminal Justice Department
Topeka, Kansas
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 April 7, 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 you/your department/agency for this Conference/Membership.
You will receive confirmation of conference registration through the mail.