
| 2004 Fall Conference Registration | |
| Please fill out the section below, then print the form and send along with payment. | |
| Name: | |
| Agency: |
|
| Street: | |
| City: | |
| State: | Zip: |
|
Telephone#:: | |
| Please
Check:
CAPET
MemberSingle $400.00
Same
agency, same room, per person $300.00
Conference only $250.00 Smoking Non-Smoking Guest$40.00 | |
| Please print this form then mail this to:
CAPET | |