Federation of Chiropractic Licensing Boards
80th Annual Congress

Portland, Oregon

April 30 - May 7, 2006

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Contact

  
   
*Dr., Ms., Mr.
*First Name
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Will you be bringing a guest/spouse? Please enter guest names EXACTLY as they should appear on the guest name badge.

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Program

  
   

Will You Attend Any of the Following?
   

Wednesday, May 3

  

 FCLB Committee Meetings (1:00 - 3:00 p.m.) No extra charge
   

ACBA Board Administrators’ Meeting
(All day meeting at Western States Chiropractic College)
Please remember to also complete separate ACBA registration.

Thursday, May 4

  

New Attendee Breakfast (7:00 – 8:00 a.m.) No extra charge
   

 

 The Guest/Spouse Portland City Tour (9:00 a.m. – 12:00 noon)
by motorcoach; make sure to eat breakfast beforehand! Snacks available for purchase along the way. Cost is $35 per person.

 

 *Number of Guests    Click here for more information about the tour.

Friday, May 5

  

 

 City Lights Dinner Cruise – Board the Portland Spirit at 6:30 p.m. for a fabulous taste of Northwest Cuisine—baked salmon and carved top sirloin. Cruise the Willamette River and enjoy the spectacular Portland nightscape. Return scheduled for 9:30 p.m.
(Your complimentary ticket is provided by FCLB – additional tickets are $60 per person)
 Photo id required in order to board.

  $

 Total $ for Optional Events

Conference T-Shirts

  
     Short-sleeved Hanes Beefy T-shirts with Conference logo:
     $10 each - advance order only!
   

Quantity

     Sizes
   
    Medium
    Large
    X-Large
   XX - Large
   
$   Total $ for T-Shirts

Payment Information  
Conference Fees  

Deadline
$375

Early Bird Registration

3/03/06
$395

On-Time Registration

4/14/06
$425

Late Registration

4/15/06 and after
   
   
*REGISTRATION FEE to be paid by:
   
If registration fee is not paid by attendee,  please specify Board or Organization:
   
$ Total $ for T-Shirts
$ Total $ for Optional Events
$ Total $ for Registration
   

$

 Amount Due
   
Amount to be paid by ORGANIZATION:
Form of Payment Sorry we cannot accept American Express
Name exactly as it appears on card
Credit Card Number  (no spaces) 
Expiration Date (mm/yyyy)
3-Digit Security Code (on back of card):
Credit cards are processed by FCLB staff upon receipt of registration form
   
Amount to be paid by Attendee:
Form of Payment Sorry we cannot accept American Express
Name exactly as it appears on card
Credit Card Number  (no spaces) 
Expiration Date (mm/yyyy)
3-Digit Security Code (on back of card):
Credit cards are processed by FCLB staff upon receipt of registration form

Travel and Accommodations  
This helps both the FCLB and the Hotel plan for you.
         

Arrival Date

 Approx. Arrival Time  

 Departure Date

 Approx. Departure Time  
   
Anything else the FCLB Staff should know?
   
Are there any accessibility or dietary considerations we should know about?

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