Florida Police Chiefs Association - 2001 Mid-Winter Conference/Member Registration

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Chief Executive or Initial Registrant (FPCA Member) - $175 (If registered by December 13,2000 - $200 thereafter). Non Member - $225.00 ( If registered by December 13, 2000 - $250.00 thereafter). Please print/type name exactly as you would like your badge to read.

Name:

Rank/Title:

Department/Agency:

Address:

City/State/Zip:

County:

E-mail:

Telephone:

Fax:

Registration Fee:

Additional Command Staff Member (FPCA Members) - $125 (If registered by December 13,2000) $150 thereafter. Non Member Command Staff - $175.00 ( If registered by December 13, 2000 - $200.00 thereafter). Please print/type name exactly as you would like your badge to read.

Name
Rank/Title
Department/Agency

PAYMENT INFORMATION:

Payment Type:
Purchase Order #:
Credit Card#:
Expiration Date:
Name on Credit Card:

Hotel Information: The conference will be held at the World Golf Village Renaissance Resort which is located directly off Interstate 95 at 500 South Legacy Trail, St. Augustine, Florida 32092. For reservations call the hotel at 1-904-940-8000 or FAX them at (904) 940-8008. Be sure to mention that you are with the Florida Police Chiefs Association. Our room rate is guaranteed at $99 per night, providing that you register no later than December 14, 2000. Click Here for Driving Directions from Yahoo Maps.

Please print and mail your completed form to: Florida Police Chiefs Association, Conference Registration, P.O. Box 14038, Tallahassee, FL 32317-4038, or FAX it to us @ 850-219-3640.

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Name:
Rank/Title:
Department/Agency:
Address:
City/State/Zip:
County:
E-mail:
Telephone:
Fax: