MICHIGAN ANNUAL 9-1-1CONFERENCE
May 12, 13 and 14, 2003
AMWAY Grand Plaza Hotel, Grand RapidsMichigan
R E G I S T R A T I O N F O RM
Last Name _____________________________ First Name ________________________
Title ____________________________________________________________________
Organization _____________________________________________________________
Address ________________________________________________________________
City ________________________________ State __________ Zip Code ____________
Phone (Work) ________________________ Fax (Work) __________________________
CONFERENCE REGISTRATION FEES
:
DAY PASS ON TUESDAY OR WEDNESDAY DOES NOT INCLUDE LUNCHEON
| Full Conference Registration | $ 100.00 |
** Indicate which day for day pass registration ** |
||
| Day Pass Only – Per Day | $ 50.00 | Monday, May 12, 2003 | ||
| Opening Luncheon Only | $ 35.00 | Tuesday, May 13, 2003 | ||
Guest Registration – Full $ 75.00 Wednesday, May 14, 2003 Guest Name:
NO PURCHASE ORDERS – PAYMENT MUST ACCOMPANY REGISTRATION
___ VISA ___ MASTERCARD ___ AMERICAN EXPRESS___ CHECK*
*Make Checks Payable to: MICHIGAN NENA
ACCOUNT # ____________________________ EXPIRATION DATE: _____________
NAME ON CREDIT CARD ________________________________________________
AUTHORIZED SIGNATURE _______________________________________________
| RETURN COMPLETED FORM TO: | 9-1-1 Conference Registration |
| c/o Cindy Pilon, Midland Co 911 | |
| Pre-Registration Deadline | 2727 Rodd Street |
| May 2, 2003 | Midland, Michigan 48640 |
| FAX: (989) 839-6476 |