2013 Summer Operator Registration Form

Conference registration includes admission to all sessions, receptions, and meals.

Name*
FirstLast
Preferred Name on Badge*
Title*
Company Name*
Phone*
Email*
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Premium Items
- I will be contributing premium item(s) for the PAC Auction
Number of Premium Items
Registration fee for GM or first system operator
Price: $350.00 Quantity:
Registration fee for additional operator
Price: $300.00 Quantity:
Additional Registration Fee: Please fill out a separate registration form here
Spouse/Guest Fee
Price: $300.00 Quantity:
Guest/Spouse Name for Badge
Golfing (optional) per person
Price: $190.00 Quantity:
Spa Day (optional)
Price: $190.00 Quantity:
Additional Fee for Late Registration (received after July 26, 2013)
Price: $75.00 Quantity:
Total
$0.00

Idaho Cable Telecommunications Association