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PLC:

a0053s

Agency:

texas chief deputies association

For:

attendee registration

Phone:

512-348-1739

Address:

5815 82nd suite 145,box 125
lubbock, texas 79424

*Required Field

Payment Information

*Registration Type (Choose all that apply):

TCDA Board Member $270

TCDA Member $270

New Chief $270

First Time Attendee $270

Lifetime Member $240.00

NOTE: Your $270.00 payment includes yearly membership fee. Lifetime Members pay the Conference Registration Fees only.

*Attendee Name:

Middle:

*Last:

*Will a Spouse be joining you?:

Yes

*Will your spouse be participating in the family events?:

Yes

*Will your spouse be participating in the spouse event?:

Yes

Spouse's Name:

How many children will be accompanying you?:

*Will the children be participating in the family events?:

Yes

Children's Name(s) and age of each child:

*PID:

*Title:

*Sheriff Office/Business name:

*County:

*Address:

*City:

*State:

*Zip:

*Phone:

(### - ### - ####)

*Email:

*Date of Birth:

(Month / Day / Year)

Participants who attend all training sessions are eligible for up to 23 hours of TCOLE credit.

Refund & Cancellation Policy

*I acknowledge that I have reviewed the information provided above at the available link, and I agree to the terms and requirements for Refund & Cancellation Policy.:

*Refund & Cancellation Policy Acknowledgement:

Yes

*I certify to the best of my knowledge, the information reported above is complete and correct:

Yes

QUESTIONS? Contact TCDA at tcda1986@gmail.com

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Subtotal:

$0.00

Service Fee:

$0.00

Total:

$0.00

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Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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