| Please fill out your registration information as completely as possible. Fields marked with ** are REQUIRED and must be filled in! |
| ** Event |
Adjudication Certification Training
Wed, November 8, 2023, 8:30am - Thu, November 9, 2023, 12:00pm
Las Vegas Tuscany Suites & Casino
255 E Flamingo Rd.
Las Vegas, NV
Tuition: $550.00 |
| Registrant Info (the person filling out this form) |
| ** Registrant First Name |
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| ** Registrant Last Name |
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| ** Registrant Email |
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| ** Registrant Phone |
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| Attendee Info (the person actually attending the event) |
| Social Title (Dr/Mr/Ms/Etc) |
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| ** Attendee First Name |
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| Attendee Middle Name |
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| ** Attendee Last Name |
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| Attendee Name for Certificates and Nametags |
Enter the attendee name as it should appear on certificates, nametags, sign-in sheets, etc. (if different)
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| ** Tribe/Organization/Company |
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| ** Title |
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| ** Attendee Email |
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| ** Attendee Phone |
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| Attendee Cel |
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| Attendee FAX |
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| ** Attendee Street |
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| Attendee Street 2 |
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| ** Attendee City |
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| ** Attendee State/Province |
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| ** Attendee Zip/Postal Code |
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| ** Attendee Country |
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| Additional Info |
| ** Registrant Background |
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| ** Payment Method |
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| ** Billing Email |
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| ** Billing Name |
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| ** Billing Address - Street |
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| Billing Address - Street 2 |
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| ** Billing Address - City |
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| ** Billing Address - State |
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| ** Billing Address - Zip |
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| ** Billing Address - Country |
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| Other Information |
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| How did you hear about the event |
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| ** Accept Registration Terms |
IMPORTANT - PLEASE READ!
You will be responsible for the registration fee if you cancel after seven days prior to the training event.
Check to AGREE. (See Terms and Policies) |
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