LSI's 2nd Quarterly Conference "FALL INTO WINTER" November 9-11, 2018 Silver Legacy Resort 407 N. Virginia Street, Reno, Nevada 89501 www.silverlegacyreno.com Please use the form below to register. If you choose to pay by Pay Pal or credit card a $3.00 surcharge is added to the price of registration and you will be taken to Pay Pal to complete payment. Note, you can use your credit card with Pay Pal if you do not have or do not want to use a Pay Pal account. A $10 fee will be added to registrations made after October 9, 2018 Please fill out a separate form for each attendee. Download the Registration FormName of Attendee (as it will appear on badge):* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Cell/Home PhoneWork PhoneLocal AssociationLSA / LPA LSA LPA Please check if you are: President Govenor CCLS PLS Please check if applicable (include title): State Officer State Chairman Title:Payment Method*By Pay Pal or Credit CardBy CheckScrip TicketsScrip Ticket (includes Registration, Welcome Reception, Banquet and Brunch) Scrip Ticket Scrip Ticket (includes Registration, Welcome Reception, Banquet and Brunch) Scrip Ticket Individual TicketsIndividual Tickets Registration Welcome Reception (Friday) President's Luncheon (Saturday) Governor's Luncheon (Saturday) Open Luncheon (Saturday) Banquet (Saturday Night) Brunch (Sunday) Individual Tickets Registration Welcome Reception (Friday) President's Luncheon (Saturday) Governor's Luncheon (Saturday) Open Luncheon (Saturday) Banquet (Saturday Night) Brunch (Sunday) Total $0.00 MEAL CHOICES Please select a meal option for each ticket you order. If you ordered a scrip ticket please remember to make a choice for the Banquet.President's LuncheonChicken Ciabatta SandwichChicken Cobb SaladGovernor's LuncheonChicken Ciabatta SandwichChicken Cobb SaladOpen LuncheonChicken Ciabatta SandwichChicken Cobb SaladBanquetPrime RibPorkChickenSpecial Dietary Request:VegetarianGeneral CommentsNOTE: Cancellations must be received 24 hours in advance for a refund. No-Shows will be billed. NOTE: Cancellations must be received 24 hours in advance for a refund. No-Shows will be billed. Once you submit this form, you will be sent an e-mail that you can print and send it with your check. Please make you check payable to: SCCoLPA NOV 2018 CONF. Return the form and payment to: M'Liss Jarvis Bounds c/o Hoge, Fenton, Jones & Appel, Inc. 60 South Market Street, #1400 San Jose, CA 95113 Phone: (408) 938-3808 Email: sccolpaconference@gmail.com