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Member/Guest Registration Form

Chief Executive or Initial Registrant (FPCA Member) - $225 (If registered by December 10, 2007 - $250 thereafter). Non Member - $275.00 (If registered by December 10, 2007 - $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 $100 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 10, 2007) $225 thereafter. Non Member Command Staff - $225 (If registered by December 10, 2007 - $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:
Billing Address:

Hotel Information: The FPCA room block at the Renaissance Resort at World Golf Village has been filled. Limited rooms may still be available at the Hampton Inn - St. Augustine/I95. Contact them at (904) 824-4422. 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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