CSI Gulf States Region Leadership Conference Registration
August 1 & 2, 2008 -- It's a Memphis Thing!
Q.1
Member Name
*
Mr/Mrs
First Last, Suffix
Nickname for Badge
Q.2
Spouse Name
Mr/Mrs
First Last, Suffix
Nickname for Badge
Q.3
Member Email Address
*
(e.g. john@hotmail.com)
Q.4
What Chapter are you be representing?
*
Acadiana
Baton Rouge
Birmingham
Chattanooga
Gulf Coast
Huntsville
Knoxville
Little Rock
Memphis
Mississippi
Mobile Bay
Montgomery
Nashville
New Orleans
Pensacola
Shreveport
list if other
Other:
Q.5
Mailing Address
*
Company Name
Street Address
City
State
Zip Code
Q.6
Billing Address
leave blank if same as above
Address Line 1
Address Line 2
City
State
Zip Code
Q.7
Registration Type(s)
*
provide special requests in "other" box if necessary
Attendee
Student
Spouse Tour
Golf
Other:
Q.8
Payment Method
*
provide special requests in "other" box if necessary
I will mail a check. no bill required
Online paypal payment
Send me a bill
Other:
Q.9
Please list below any special needs or dietary requirements for you and/or your spouse.
Q.10
I'm attending this event because...
*
I want to network
I want to see old firends
I want to be more invoved at the region level
I look for any excuse to hang with my CSI buddies
I want to support the Memphis Chapter of CSI
I want to learn more about CSI
I look for any excuse to get out of the office
My boss made me
I am a chapter officer and/or committee member
Other:
