2009 INDIANA NENA CONFERENCE ATTENDEE REGISTRATION FORM
(Please Print)
Name: (first)___________________________________ (last)______________________________ Title:________________________________________ Phone:_____________________________ Organization:___________________________________________________
First time attendee? Yes No
Mailing Address:___________________________________________________________________ E-Mail:________________________________________ NENA Membership #:________________
CONFERENCE REGISTRATION FEES
EARLY REGISTRATION RATES Member: Non-Member: Vendor Show: Banquet Only: Day Pass: Specify day(s): Training Courses School Violence
(only until 03/01/2009)
LATE REGISTRATION RATES Member: Non-Member: Vendor Show: Banquet Only: Day Pass: Specify day(s): Training Courses School Violence
(after 03/01/2009)
$175 = $________ $195 = $________ $ 90 = $________ $ 45 = $________ ____ x $ 100 = $________
Wed Thurs Fri
$200 = $________ ____ x $220 = $________ ____ x $100 = $________ ____ x $ 55 = $________ ____ x $125 = $________
Wed Thurs Fri
__________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_________________________________________________________________________________________________________
________________________________________________________________________________________________________________
____ x$100 = $________
Tues 3-31-09 4-1-09
____ x$125
= $________
Tues 3-31-09
Handling Search & Rescue/Active Shooter Incidents Mon 3-30-09
Handling Search & Rescue/Active Shooter Incidents Mon 3-30-09
Handling High Profile Media Incidents Wed (4hr session + Breakfast and Opening Ceremonies) Domestic Violence (4hr + Vendor show) Thurs
Handling High Profile Media Incidents Wed 4-1-09 (4hr session + Breakfast and Opening Ceremonies) Domestic Violence (4hr + Vendor show) Thurs 4-2-09
4-2-09
Dealing with Alzheimer’s Patients Fri 4-3-09 Wed, Thurs and Fri classes are included in Full Conference Registration
Dealing with Alzheimer’s Patients Fri 4-3-09 Wed, Thurs and Fri classes are included in Full Conference Registration
TOTAL AMOUNT DUE:
$________
TOTAL AMOUNT DUE:
$________
Attending
___________ ___________
FREE TRAINING Opportunity ILEA Accredited
National Center For Missing and Exploited Children (NCMEC)
Monday March 30, 2009 8am – 4pm NCMEC CEO Seminar geared toward Sheriff/Chief (First Line Supervisors) Tuesday March 31, 2009 8am – 4pm NCMEC 1 Responder Seminar (Detectives, First Officers on Scene, Dispatchers)
st
PAYMENT INFORMATION Payment (circle one): Check Money Order
Name: _________________________________________________________________________________ MAIL OR FAX REGISTRATION FORM & PAYMENT TO: Indiana -NENA Conference, Attention: Cindy Snyder, 205 S. Martha St. Ste 102, Angola, IN 46703 fax 260.665.5469 e-mail: registration@innena.org
ALL PAYMENTS MUST BE SENT TO THE ANGOLA ADDRESS OR FAX
The National Emergency Number Association(Indiana-NENA) is a non-profit 501c(3) association, tax ID number 20-0923577.
NO REFUNDS WILL BE GIVEN AFTER MARCH 1, 2009.