Online Submit Date

Name Badge and Registration Information
Name

Title

Department

OACP District #

Mailing Address

City

State Zip

County

E‐mail

Work Phone

Fax

Please Indicate If:

PELC Grad Yes

CLEE Grad Yes

GUEST/SPOUSE ATTENDING FOR AN ADDITIONAL $140? Yes
(Includes same room lodging & meals)
If yes, please give name for name badge

Membership Dues for the next period
(October 1, 2010 – September 30, 2011)

PLEASE INDICATE BELOW THAT WHICH APPLIES TO YOU FOR THE ABOVE PERIOD: (you will be invoiced separately for dues)
Active $195
Sheriff $175
LEA $75
Associate $125
Life $25

Costs: (check below that which applies to you)
*$455 (BEFORE 3/25/10) CIS/AC
*$475 (AFTER 3/25/10) CIS/AC
*$140 (guest/spouse) CIS/AC
*(Includes meals, lodging and breaks)
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Please enter your Total Due (Registration & Dues)

NOTE: You will be invoiced separately for CIS/AC and for Dues.

Electronic invoice(s) will be sent to your email address noted above. Please print the invoice(s) and send a copy of the invoice(s) along with your payment.

HOTEL: Room reservations will be made by OACP. You do not need to contact the hotel. THANK YOU!