Title

County/Company

Address

City State Zip

E-mail Address (required field)

Telephone Number Fax Number

Spouse Name (If Attending - $30 registration)

Register early and save - registration fee is $185 until 1/23/12.

After January 24, 2012 and on-site registration fee is $200.

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

Cancellation policy: A full refund will be given if cancallation is received prior to January 24, 2012