33rd National Conference on Preventing Crime in the Black Community

Conference Registration Form
May 30 - June 1, 2018 in Jacksonville, Florida

asterisks indicate required information

Attendee Information Salutation: First Name: Middle Initial: Last Name: Age Group: Chaperone: (for K-12 only) Job Title / School: Organization: Work Phone: Home Phone: Cell Phone: Email: Sworn Officer: Attendance Type: *Payments received after May 18, 2018, late fee of $25 will apply.	Attendee Address Address1: Address2: City: State: County: Specify County: Zip: Plus 4:
	Billing Address Same as Attendee Address? Yes Address1: Address2: City: State: County: Specify County: Zip: Plus 4:
Americans with Disabilities Act (ADA) Special Accomodations:	Security Question Please answer this common sense answer to restrict automated spamming programs. Different Security Question