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Conference Registration (Mail In)
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Western Colorado Peace Officers Association
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Spring Conference 2011
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Grand Junction, Colorado
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April 19, 20 & 21
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Please return this form along with your check no later than April 11, 2011.
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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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2011 Membership Only
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$35 each =
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$______
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(Includes 2011 membership, conference & banquet)
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Attending conference
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Yes - No
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Attending banquet (April 20) |
Yes - No |
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Additional Banquet Tickets - Spouse/Guest
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$25 each =
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$______
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(Guests welcome) |
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TOTAL PAYMENT ENCLOSED
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$______
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