CIT Regional Conference 2017 - Registration

Attendee Registration

The CIT Regional Conference is October 3-5, 2017, at the Riverhouse on the Deschutes in Bend, OR. The conference includes three full days of training from 8 AM - 5 PM daily, some meals, and all attendees are provided a complimentary ticket to the awards dinner banquet that includes dinner, keynote speaker, and charity fundraiser.

Addidtional Training: CIT International Coordinator Certification (October 6, 2017, 8 AM - 5 PM)

Conference details visit www.cithappens.com.

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* 1. Attendee Registration Details

First Name

Middle Initial

Last Name

Agency Name

City

State

Zip Code

Email - work

Email - alternate

Cell Phone

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* 2. Agency Type

Law Enforcement

Corrections

Behavioral Health

Fire/EMS

Community Resource

Government - Other

Educational Institution

Other (please specify)

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* 3. Registration Type

Conference Registration Only - October 3-5, 2017, $150 fee per person

Conference Registration + CIT International Coordinator Certification - October 3-6, 2017, $250 fee per person

CIT International Coordinator Certification Only - October 6, 2017, $300 fee per person

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* 4. Billing Details ( Agency will be invoiced after the conference )

Billing Name

Billing Agency

Billing Address

City

State

Zip Code

Billing Email

Billing Phone

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* 5. Alternate Billing Details (Fill in all that apply)

Yes! Bill Full Conference Registration Only to

Yes! Bill Full Conference Registration + CIT International Coordinator Certification to

Yes! Bill CIT International Coordinator Certification Only to

Yes! Bill Guest Awards Dinner Banquet Tickets to

Alternate Billing Address

City

State

Zip Code

Alternate Email Address

Alternate Phone

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* 6. Food and Beverage Options

Regular Meals

Gluten Free

Vegetarian

Dairy Free

Food Allergy (list in notes)

Other/Food Allergy (please specify)

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* 7. Optional Add-Ons

Guest Awards Dinner Banquet Ticket, October 4, 2017, $30 fee per person

Guest Full Name

Guest Meal Type (Regular, Vegetarian, Gluten Free, Dairy Free, Other)

Thank you for completing the CIT Regional Conference 2017 Attendee Registration. PRINT THIS PAGE PRIOR TO SUBMISSION of Registration for your personal copy. Invoices will be sent out via email and us mail. We look forward to seeing you in Bend, Oregon, this fall.

Conference details can be found at: www.cithappens.com.
Questions or Cancelations contact: Glenda Coms | gcoms@cjtc.state.wa.us | 206.835.7340