Conference Registration
Department Name: _____________________________________________
Department Address: ____________________________________________
City:
Department Phone: ___________________ Dept. Fax: _________________
Attendee Name: ____________________ Tank/Title: __________________
Address:
Phone: _____________________ Email: ____________________________
Guest/Spouse: _________________________________________________
Will
you need extra banquet tickets?
___ Yes ___ No How
many? _____
Guest attending Ladies’ Program?
___ Yes ___ No
Will
you attend Men’s Golf Outing? ___ Yes
___ No
Will
you attend Men’s Skeet Shoot? ___ Yes
___ No
Registration Fees
Pre-Registration: $65.00 per person: Number of attendees ___ X $65.00 = ___________
February 01, 2011 through July 15,
2011
Registration at Conference: $85.00 Number of attendees ___ X $85.00 = ___________
After July 15, 2011
Total Remitted: ____________________________
Make Checks Payable to: KFA 2011
Mail Registrations and Payment to:
KFA 2011