Name*

Title*

County*

Daytime Phone Number (no dashes)*

Mailing Address*

Email*

Spouse/Guest (if attending)

First-Time KCCA Annual Conference Attendees

The KCCA Executive Committee is offering a meeting registration scholarship for the first ten commissioners registering to attend their first KCCA Annual Conference. Interested? Register and request a fee waiver. Applicants will be notified of their status as registrations are processed.

Yes

I am a First-Time KCCA Annual Conference Attendee - I'd like to request a fee waiver (you will be notified if your fee will be waived).

Please Register for the following

Check all that apply*

Base Conference Registration - $130 County Budgeting Basics (Tue, May 4) - $109 Spouse Program (Wed, May 5 ) - $40

Wednesday Evening Dinner (extra ticket) - $30 Please check if you require special assistance to enable your conference participation (including special dietary needs)

The "Base Conference Registration" includes Tuesday reception, Wednesday and Thursday meals, and all educational workshops on Wednesday and Thursday except the Pre-Conference Workshop.

Payment*

Enclosed total payment

Please bill my county

Checks payable to:
KCCA, 300 SW 8th, 3rd Floor, Topeka, KS 66603

Fax Registration: 785-272-3585

Register Online: www.kansascounties.org

Cancellation Policy: All refund requests must be made in writing. For a full refund, cancellation must be received on or before April 23, 2010. No refund request will be honored after April 23, 2010.