ILLINOIS ASSOCIATION OF CHIEFS OF POLICE
2008 SUMMER TRAINING CONFERENCE

Grizzly Jack’s Grand Bear Resort at Starved Rock – Utica, IL

REGISTRATION FORM

 

First Name:

Middle Initial:

 

Last Name:

 

Name Tag:

 

Title:

 

Agency:

 

Office Address:

 

City:

 

State:

Zip Code:

 

Office Phone:

 

E-mail:

 

Office Fax:

 

 

 

 

Spouse/Social Guest Name:

 

 

 

 

Home Address:

 

Home City:

 

State:

Zip Code:

 

Home Phone:

 

 

 

 

Type of Payment:

Bill My Department

 

 

 

 

 

Purchase Order#:

 

 

Charge My Credit Card (VISA or MC only)

 

 

Select Type:

 

 

Card#:

 

 

Exp. Date:

 

 

Signature Name:

3 Digit PIN:

IACP Member Regis. Amt. (prior to June 13th):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Life (Retired) IACP Member Fee (prior to June 13, 2008):

 

 

 

      NON-MEMBER FEE (Prior to June 13th):

 

 

 

Spouse/Social Guest Fee (prior to June 13th):

 

 

 

Child(ren) Fee (age 8 and under,  $40 each):

 

 

 

 

* Extra Sat. Police Cross Awards Lunch Ticket(s), $30 each:

 

 

 

* Extra Sat. Police Cross Awards CHILD Ticket(s)

$20 each:

 

 

 

* Extra Sat. Eve. Cook-Out Ticket(s), $35 each:

 

 

 

* Extra Sunday Buffet Brunch Tkt(s), $30 each:

 

 

 

* Extra Sunday Dinner Ticket(s), $45 each:

 

 

 

* Extra Sunday Dinner CHILD Ticket(s), $25 each:

 

 

 

 

 

Total Amount Due: $