2010 Calif. Fire Prevention Institute (buellton) Reg Form

CFPI Registration Form 20th Annual Fire Prevention Workshop March 15-19, 2010 www.firepreventionofficers.org Name___________________________________________________________________________________ Work Address_________________________________________________________________ City, State, Zip________________________________________________________________ Work Phone__________________________ Fax________________________________ Fire Dept./Company____________________ Email Address ___________________________ FULL WEEK ATTENDANCE / MONDAY-FRIDAY Includes lunches (Monday through Thursday), all Workshop sessions, and Thursday Night Installation Banquet

$300.00 Prior to January 31, 2010

$350.00 February 1, 2010 and after $

SINGLE DAY ATTENDANCE $100.00 per day, per person (Single day attendance includes lunch does not include Thursday banquet ticket) Please circle the day(s) selected Mon. Tues. Wed. Thurs. $ INSTALLATION BANQUET Installation of incoming California Fire Prevention Officer Board Members, Semi-Formal Attire *Included in Full Week Purchase $50.00 per person otherwise $ I require a Invoice 

Total Amount Enclosed $

Method of Payment:  Cash  Check  Money Order  PO #

 Credit Card (Visa and MasterCard Only): Provide the following information: Acct #

Name on card:

Expiration Date:

Fill out registration form & class sign up sheets and return both with your payment to: Penni Overstreet-Murphy, CFPI Chairperson C/O San Bernardino County FD 620 South “E” Street San Bernardino, CA 92415-0179

Make Checks Payable to: CFPI

Personnel needing an invoice before payment must request an invoice when mailing or faxing registration form. All payments must be received by March 1, 2010. California Fire Prevention Institute is a Non-Profit Organization # 95-4833927 For Additional Information Call:

Penni Overstreet-Murphy (909) 386-8472 Fax # (909) 386-8460

Rick Rodewald @ [email protected]

[email protected] Refund Policy. Registration cancellation refunds are not permitted 3 days before the workshop. 50% refunds for registration cancellations are authorized two weeks prior to the workshop. 90% refunds are available up to one month prior to the workshop.