Registration


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Registration for:

Academy of Pacesetting States
June 14-17, 2010
Coeur d' Alene, ID

Please enter registration information and submit no later than May 7th.

Title and name (first, last):

How would you like your name to appear on your name badge?

Organization:

Position:

Address (1) - Please provide street address, not post office box:

Address (2):

City, State, ZIP:

Phone: Extension:

Alternate Phone: Fax:

Email:

Alternate Email:

The Center on Innovation and Improvement will provide accommodations for Monday, Tuesday, and Wednesday nights.
If, due to travel restrictions, you require an extra night, please check this box and contact Pam Sheley no later than May 7th to make your arrangements.