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Member/Guest Registration Form

Chief Executive or Initial Registrant (FPCA Member) - $225 (If registered by December 12, 2003 - $250 thereafter). Non Member - $275.00 ( If registered by December 12, 2003 - $300.00 thereafter). Please print/type name exactly as you would like your badge to read.  Cancellation Policy: 30 days or more notice,   will result in a refund less a $35 administrative fee. No refunds will be issued if a cancellation is made with less than 30 days notice.

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

Additional Command Staff Member (FPCA Members) - $175 (If registered by December 12,2003) $225 thereafter. Non Member Command Staff - $225 ( If registered by December 12, 2003 - $250 thereafter). Please print/type name exactly as you would like your badge to read.

Name
Rank/Title
Department/Agency
Registration Fee:

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 $119 per night, providing that you register no later than December 12, 2003. 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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