REGISTRATION
Registration costs cover all conference sessions (choice of over 20 classes), attendance to the panel, registration packet, two continental breakfasts, and two lunches.
Late Registration ($289) - after June 9, 2012
First Name
Position in Agency / Org.
Type of
Agency
Address
City
State
Zipcode
Cell Phone
Fax
Email
Verify Email
I understand that if my payment is not received in 30 calendar days (from date on this form), my registration may be removed from the attendee list.
Cancellations must be received in writing via mail, fax, or email. Requests of cancellation received prior to or on June 9, 2012 will receive a 50% refund. No refunds will be made after June 9, 2012. No exceptions.
If paying with a check, please mail payment to P.O. Box 245 Kuna, ID. 83634.
Otherwise, please click on the PayPal option, after clicking submit.
I plan on attending these meals:
Date of Registration
Name of
Agency /
Organization
This registration page is for Conference Attendees, Youth and Presenters ONLY. (Vendor? Please go to vendor page.
One registration per person.
Last Name
Work Phone
Enter any comments / special instructions here:
2012
(This will be the name on your name tag.)
My method of payment will be:
Amount of Payment:
Please make checks
payable / mail to:
Idaho Youth Alcohol & Drug Prevention & Education Program
P.O. Box 245
Kuna, ID. 83634
Northwest Alcohol Conference
Type of
Attendee
By clicking "Submit", I agree to the above terms and conditions. I also allow Northwest Alcohol Conference to reserve a "spot" for me, and as such, I will expedite payment to them.
Chaperons are for Youth Track Only.
