Registration Form w/ Credit Card

2024 Conference Registration & Credit Card Payment w/ Square

To Register for the Conference and pay with a credit card, you must complete the registration form below for each individual attending. Online credit card payment includes a $8 credit card convenience fee. If bringing a non-registered guest(s), be sure to make selections for additional meals below. Fees are non-refundable for no-shows.

"*" indicates required fields

County*

Agency Name*

Name*

First Last

Job Title*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Extension

Choose a Group

Registration Fees (includes all breaks/meals for the day you register):

Full Conference – Wed, Thur, Fri - $225 + $8 Credit Card Convenience Fee

Two-Day Conference – Wed & Thur - $190 + $8 Credit Card Convenience Fee

Two-Day Conference – Thur & Fri - $190 + $8 Credit Card Convenience Fee

Add-On Meal Rates (for non-registered conference guests only)

Banquet – Wednesday Evening

Breakfast – Thursday

Lunch – Thursday

Breakfast – Friday

Total

Secure Credit Card Payment w/ Square

Cardholder Name

Card Details

Name

This field is for validation purposes and should be left unchanged.