2019 Winter Conference Registration

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Email *

First Name *

Last Name *

Which County do you work for? *

Job Title *

I will be attending the General Session on Thursday *

Yes

I will be attending the General Session on Friday *

Yes

I will be attending the Human Services Session on Thursday *

Yes

I will be attending the Human Services Session on Friday *

Yes

I will be attending the Thursday evening dinner *

Yes

I will be bringing a guest(s) to the Thursday evening dinner? *

Yes

First and Last Name of Guest #1

Guest #1

Adult ($15)

Child 13 and older ($15)

Child 6 to 12 years ($10)

Child 5 and younger (Free)

Clear selection

First and Last Name of Guest #2

Guest #2

Adult ($15)

Child 13 and older ($15)

Child 6 - 12 years ($10)

Child 5 and younger (Free)

Clear selection

First and Last Name of Guest #3

Guest #3

Adult ($15)

Child 13 and older ($15)

Child 6 - 12 years ($10)

Child 5 and under (Free)

Clear selection

First and Last Name of Guest #4

Guest #4

Adult ($15)

Child 13 and older ($15)

Child 6 - 12 years ($10)

Child 5 and younger (Free)

Clear selection

A copy of your responses will be emailed to the address you provided.

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