Indiana Fire Investigation Conference Registration

Date  

Name of Attendee  Agency Representing

Email AddressHome Tel# Work Tel# Cell#

 Billing Information

Payment must be received before the first day of the conference.

Authorized Billing (FD/Organization/Unit, etc.)

Name, rank  and/or title of the individual who authorized this payment

Tel # of individual who authorized payment Ext Other 

Authorized Billing Address

CityStateZip

Payment Type Choose One Visa MasterCard Purchase Order Mailing in Payment Specify Other Call in credit card info/under construction

Cancellation Policy:  The last day to cancel is August 4, 2008.  The billing agent will be responsible for the full conference fee if any cancellations are made after this date or the registrant is a "no show" to the conference.  We appreciate your understanding with this matter.  At the time of cancellation you will receive a cancellation number, please keep this for your records.

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