2011 JDCAP Annual Conference Registration (Non-Members) October 5-7, 2011
Attendee Information
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State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
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Days Attending (Check all that apply):	Full Conference: $325 Wednesday Only: $100 Thursday Only: $150 Thursday Banquet Only: $65 Friday Only: $85

Miscellaneous

Please list any special dietary or physical accommodations or needs as described by The Americans with Disabilities Act (ADA)

Payment and Cancellation Information

Cancellations must be submitted via email to Lori Lawyer and must be received by 4 pm on September 2, 2011 to qualify for a refund. NOTE: No requests for refunds of the registration fee will be honored after that date. However, if last minute schedule changes prevent you from attending the meeting, another may attend in your place. A $25 administrative fee will be deducted from all refunds issued. ALL REGISTERED NO SHOWS WILL BE BILLED.

I do not want to receive notifications, updates, and other PCYA mailings via email.

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Please verify the information entered above is correct, and press the button to register

By submitting this form, you acknowledge that the name, title, agency, and email above will be included on the attendee list that will be shared with all other conference participants.

Questions? Please contact:
Wayne Bear, (717) 232-7554 x3117