FCLB Conference Registration

1. Please fill in ALL fields on the form.

2. Print a copy of this form for your records by using your browser print feature.

3. Click on the SUBMIT button at the bottom of the page. (If you don't click SUBMIT we won't get your registration.)

4. A confirmation page will be displayed once you submit your transmission indicating that the online registration was accepted.

Dr., Ms., Mr. *

*First Name

*Last Name

*Title

*Address (note-this address will appear in the conference notebook)

Address
(Continued)

*City * State/Province * Zip/Postal Code

*Representing

*Day Phone Home Phone (for FCLB use only - not distributed)

*Fax *Email

Will you be bringing a guest/spouse? Please enter guest names EXACTLY as they should appear on the guest name badge
Guest 1 Guest 2

*Have you previously attended an FCLB Conference?

*Registration Status

Will You Attend Any of the Following?

Wednesday, May 4:

* FCLB Committee Meetings: 1:00 PM - 3:00 PM

* ACBA Board Administrator's Meeting: All Day - Includes Lunch

Thursday, May 5:

* New Attendee Breakfast - 7:30 -8:30 AM

* The Guest/Spouse tour in Montreal, scheduled for Thursday, May 5, 2005, is now full. We are accepting names on a waiting list. Please contact Bridget at 970-356-3500 or email bseader@fclb.org to add your name (s) to the list. If seats become available, she will contact you. Thank you. Cost is $40 per person

Friday, May 6:

* Group Event at the Cirque du Soleil. We have purchased a very limited number of tickets, available first-come, first served. There will be a reception prior to departure, featuring hor d’ouvres and a cash bar.

Cost is $65 per person (your ticket is included in the registration fee).

Additional Amenities:

Conference T-Shirts

Short-sleeved Hanes Beefy T-shirts with conference logo

$10 each - advance order only!

* Would like to order conference T-Shirts?         Sizes/Quantity Medium
                                                                                                                            Large
                                                                                                                            X-Large
                                                                                                                            XX-Large

Payment Information

Conference Fees		Deadline
$375	Early Bird Registration	3/24/05

$395	On-Time Registration	4/14/05

$425	Late Registration	4/15/05 and After

Registration fee to be paid by *

Please Specify Board or Organization

Amount to be paid by attendee

Form of Payment (Please note: we do not accept American Express)

Credit Card Number (no spaces)

Expiration Date (mm/yyyy)

Name on card

Amount to be paid by Board or Organization

Form of Payment (Please note: we do not accept American Express)

Credit Card Number (no spaces)

Expiration Date (mm/yyyy)

Name on card

Please Tell Us Your Travel Plans
(Note: This helps both the FCLB and the Hotel plan for you)

Arrival Date Approx. Arrival Time

Departure Date Approx. Departure Time

Talk To Us: Anything else the FCLB Staff should know?

Special Accommodations

Are there any special accommodations you need to make your (or your guest's) conference experience more comfortable?
(i.e., hearing assistance, accessibility, diet considerations)

Stop!

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