Oct 25, 2012 ... Complete a separate registration form for each attendee ***. Membership is
Required to Attend TCPA Conference (Download application and ...
Registration Form Alamo Area Crime Prevention Association 38 Annual Texas Crime Prevention Association Mid-Winter Conference ~ Kerrville, Texas th
January 14 - 17, 2013
Jan 13th there will be early registration, TCPA Exc. Board Meeting, CCPS Review, and Ice Breaker/Presidential Reception. The CPII class will be from Jan 14-18
*** Complete a separate registration form for each attendee *** Membership is Required to Attend TCPA Conference (Download application and submit $30 dues separately at www.tcpa.org ) Program and lodging information: www.tcpa.org Last Name
First Name
(Name As It Appears On Your TCLEOSE Record if Applicable)
Agency/Organization:
P.I.D. Number:
Mailing Address: City:
State/Province:
Work Phone: Email:
(
)
Home Phone:
(
Zip/Postal Code: )
Cell: Please circle conference t-shirt size:
S
) M
XL
2XL
Yes
REGION AFFILIATION:
Alamo Area
Central Texas
East Texas
Far West Texas
South Texas
Texas Gulf Coast
Texas Chisholm Trail
West Texas
CONFERENCE FEES: 1. Registration Fees: Includes Conference fees, training, luncheon & banquet.:
Taking the CCPS test?
L
Will you be attending the CCPS study session?
North Texas
No
(
Yes
3XL
No
PLEASE CHECK ONLY ONE OF THE NEXT FOUR BLOCKS BELOW:
TCPA Conference Registration postmarked and paid on or BEFORE DECEMBER 1
$95.00
TCPA Conference Registration postmarked and paid AFTER DECEMBER 1
$115.00
Crime Prevention Two Class (40 hour class with reduced conference fee included) – see cancellation policy below
$250.00
C.P.T.E.D. (24 hour class with reduced conference fee included) – see cancellation policy below
$250.00
(Classes must have a minimum of 20 persons registered by Dec. 1 st or classes will be cancelled) 2.
x $23/per guest
Guest Lunches (Tuesday) Indicate number of guests: _____
= $ ____________
Print full name of guest(s): __________________________________________________________________ TOTAL ENCLOSED: $ ___________
Check here if vegetarian or special meals are required: Self Guest(s) Special instructions: _____________________________________________________________________________________________________ PAYMENT METHOD Check or Money Order must be in U.S. funds payable to: AACPA. There will be a $25.00 fee charged on checks returned by the bank due to insufficient funds. Please check appropriate payment type: Check Money Order Online PayPal CANCELLATION POLICY: A refund, less $25.00 processing fee is available until December 1, 2012, and will be issued after the conference. No refunds after December 1, 2012. All requests must be mailed to the conference address listed below and postmarked prior to December 1st. CP II & C.P.T.E.D. classes must have a minimum of 20 persons registered by December 1st or classes will be cancelled. Conference staff will notify each person registered for the class who will have the choice of a full refund or refund, minus the $95.00 conference registration fee (and any additional guest tickets if applicable). REGISTRATION INFORMATION: Remember to complete a separate form for each attendee. If paying for multiple attendees, staple all completed registration forms together with check or money order. We regret that TCPA is unable to accept cash, government purchase orders or credit cards. Forms must be postmarked as indicated. Attendees are responsible for making their own hotel reservation. The room rate is $70.00/night + taxes (includes full breakfast). SCHOLARSHIP RECIPIENTS: If you received a scholarship, check here Scholarship covers registration fees only. Please complete and submit the registration form. LIFE MEMBERS: If you are a Life Member, check here Please complete and submit this registration form. EXHIBITORS: Contact Katheryn Dodson, Exhibitor Coordinator at
[email protected] or phone at 214-671-3739. Vendor registration forms are also available online at www.tcpa.org. CONFERENCE COORDINATOR: Paul Gonzales ~
[email protected] TCPA Tax Exempt ID Texas 17424039158 Mail or EMAIL Registration Form with Payment to: Hotel Reservations: use code TCP1 TCPA Mid-Winter Conference Registration YO Ranch Resort Hotel and Conference Center 10317 Vigilante Trail 2033 Sidney Baker St. Converse, TX 78109 Kerrville, Texas 78028 Direct Line to Hotel: 1-888-300-1093 http://yoranchhotel-px.trvlclick.com/ For conference staff use only: Amount Received:
Date Received: Check/Money Order:
Date Prepared: Membership Current:
Processed by: Yes
No
Region:
Revised 10-25-12
