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* 1. Credit Union Name:

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* 2. Name:

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* 3. Name(s) of additional attendees:

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* 4. Attendance for Networking Dinner on April 22:

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* 5. Attendance for April 23 Conference:

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* 6. Payment:

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* 7. (Required if paying by TRICORP account) By including my name below, I authorize you to debit my TRICORP account for $140 per attendee:

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* 8. Are you interested in carpooling to this event?

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* 9. If yes, please provide your cell phone number and email address:

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