Conference Registration

Email*

Full Name*

Phone*

Organization or County of Employment*

What days will you attend?*

Day 1 - Evening Networking Reception

Day 2 - Training Day

Day 3 - Roundtable Discussion

Dietary restrictions*

If you are not a vendor, please skip to the next page.

If you are attending, will you also be providing a vendor table during training day?

Yes

No

I am attending as:*

A Member

A Non-Member

Vendor/Sponsor

Total

Billing Address*

Street Address City State ZIP Code

Credit Card*

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

CJPA 2024 Fall Conference Registration