Office of the Attorney General
Pam Bondi
27th
National Conference on
Preventing Crime in the Black Community
May 16 - 18, 2012
in
Tampa
,
Florida
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CONFERENCE REGISTRATION FORM
Registration fees prior to May 2, 2012:
Adult Registration $265.00
Teen Registration $150.00
asterisks indicate required information
Attendee Information:
First Name:
Middle Initial:
Last Name:
Salutation:
If Other:
Age Group:
Job Title / School:
Chaperone:
(for K-12 only)
Work Phone:
Home Phone:
Cell Phone:
Email:
Sworn Officer:
Attendee Address
Organization:
Address1:
Address2:
City:
State:
County:
Zip:
  
Ext:
Americans with Disabilities Act (ADA):
Special Accomodations:
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