Florida Police Chiefs Association - FPCA OnLine: 2004 Summer Conference

Marriott's Bay Point Resort Village
4200 Marriott Drive
Panama City Beach, FL 32408 - June 27 - July 1, 2004.

Chief Executive or Initial Registrant (FPCA Member) - $300 (if registered by May 26 - $350 thereafter). Includes one ticket to Host Chief's Night, Installation Banquet, and Farewell Breakfast. (Please print/type name 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
Telephone:	Fax E-Mail

Activities
I will attend the Exposition & Reception on Sunday? Yes No
I will attend Host Chief's Night on Monday? Yes No
I plan to participate in the Golf Tournament on Sunday? Yes No
I will attend the Banquet on Wednesday? Yes No
I will attend the farewell breakfast Thursday? Yes No

Spouse - $75 (if registered by May 26 - $95 thereafter).
Includes one ticket to Host Chief's Night, Installation Banquet, and Farewell Breakfast.

Spouse's Name:

Youth(s) - $50 (if registered by May 26 - $70 thereafter).
Includes tickets to Host Chief's Night and Farewell Breakfast. Tickets for the Installation Banquet must be purchased separately.

Name & Age:
Name & Age:
Name & Age:

Additional Staff (FPCA Member(s) - $250 (if registered by May 26 - $300, thereafter).
Includes one ticket to each event. (Please print/type name as you would like your badge to read.)

Name
Rank/Title
Department/Agency

Non FPCA Member(s) - $350 (if registered by May 26 - $400, thereafter).
Includes one ticket to each event. (Please print/type name 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:
Signature:

Hotel Information:
Hotel accommodations will be handled directly by Marriott's Bay Point Resort Village. Call for Reservations at (800) 874-7105 or Fax Reservations to (850) 236-6153 and please mention that you are with the Florida Police Chief's Association. Be sure to call no later than May 26, 2004, to guarantee your room rate of $124 per night which will be honored three days prior and 3 days after the conference. Click here for additional details about the Marriott's Bay Point Resort Village. Click Here for Driving Directions from Yahoo Maps.

Print & MAIL or FAX completed form to:
FPCA, Conference Registration, P.O. Box 14038, Tallahassee, FL 32317, FAX 850-219-3640.