Title

County/Company

Address

City State Zip

E-mail Address (required field)

Telephone Number Fax Number

Spouse Name (If Attending) Spouse registration is $50.

Registration fee is $290. Spouse registration fee is $50.

Cancellations MUST be made by July 6, 2012 in order to receive a refund.

Please invoice the county for my registration fee. Yes   No .

I will be mailing a check for registration. Make check payable to "KCJEA". Yes   No .