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Conference Registration
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Western Colorado Peace Officers Association |
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Fall Conference 2010 |
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Grand Junction, Colorado |
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September 29, 30 & October 1 |
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Please return this form along with your check no later than September 27, 2010. |
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Make Checks payable to Western Colorado Peace Officers Association and send with this registration form to: |
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Western Colorado Peace Officers Association |
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554 Jurassic Court |
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Fruita, CO 81521 |
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If you have questions, please call Gretchen Olson at (970) 858-2249 |
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or e-mail gretchen.olson@cdps.state.co.us |
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One form per registrant - copy as needed - please print legibly |
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Name and Title ________________________________________________________________________ |
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Place of Employment ___________________________________________________________________ |
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Address _____________________________________________________________________________ |
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Phone Numbers _______________________________________________________________________ |
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Agency Phone Direct Line Cell Phone Other |
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Field of Specialty _____________________________________________________________________ |
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Please provide information on your expertise, special training, etc. |
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E-mail Address _______________________________________________________________________ |
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- Above information will be compiled in a roster and available at the meeting - |
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Conference Registration Fee |
$50 each = |
$______ |
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(Includes 2010 membership & banquet) |
Attending banquet Yes - No |
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Additional Banquet Tickets - Sept. 30 |
$30 each = |
$______ |
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(for guests not attending the conference) |
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2010 Membership (if not attending conference) |
$20 for New Members |
$______ |
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(If not attending conference) |
$15 for Renewals |
$______ |
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TOTAL PAYMENT ENCLOSED |
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$______ |
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