NCIAI 2013 Training Conference

April 16-18
Hosted by the City-County Bureau of Identification

ATTENDEE REGISTRATION FORM

Name: _______________________________________
Agency:_______________________________________
Phone Number: ________________________________________
Street Address: _________________________________________
City: ___________________ State: ______________ Zip: ______
Email: _______________________________________________
Are you an Association Member:_______If Yes, #_____________________
Amount of Enclosed Payment:____________________________
( ) YES ( ) Will you be attending the Casino Night Social Mixer
( ) YES ( ) NO

Will you be attending the Banquet?

Make checks payable to the NCIAI.

Mail, fax or email completed registration form to:
Kristie Baity,
Treasurer NCIAI
PO Box 2324 Yadkinville, NC 27055