United Trustees Association

REGISTRATION FORM- 36th Annual Educational Conference 2011 Please PRINT and FAX the registration form below. FAX: 949/260-9021 Primary Attendee Additional Attendees Additional Attendees Company Name Address City State/Provence Postal/Zip Code Email Phone Fax PRICING INFORMATION Full Conference Registration (Conference Registration Fee includes Monday Dinner Event )   First Member Attendee Registration Fee @ $595 per person (BEFORE October 7th) $ Second and Additional Member Attendee Registration Fee @ $495 per person (BEFORE October 7th) $ Non - Member Attendee Registration Fee @ $950 per person (BEFORE October 7th) $ Member Attendee Registration Fee @ $850 per person (AFTER October 7th) $ Non-Member Attendee Registration Fee @ $950 per person (AFTER October 7th) $ PAC Contribution Voluntary contributions to the Political Action Committee (CTA-PAC) will be used to promote sound legislation, oppose adverse legislative proposals and support California political leaders who foster the growth of our industry. We respectfully request a minimum contribution of 50.00 $ Please select one: Individual Corporate Monday Dinner Event Registration ONLY Spouse/Guest/Sole Attendee Fee (Monday Dinner) @ $150 per attendee (Note: Monday Dinner is included in the Conference Registration Fee) - Number of Guests: $ Attendees Attendees Certification Program 1   Certification Course @ $135 (registered attendee price, this includes lunch.) (Cost is not included in conference registration.) $ Please select one: Arizona I.... Nevada I.... Washington I.... California I.... California II Certification Course @ $185 (non-registrant fee, includes lunch) (Cost is not included in conference registration.) $ Please select one: Arizona I.... Nevada I.... Washington I.... California I.... California II Third-Party Regulators @ $50 (non-registrant fee, includes lunch) (Cost is not included in conference registration.) $ 1– UTA Members may take the course and exam. Non-members may take the courses but only UTA Members may be certified. Members must pass California Level I in order to take California Level II.   Sunday Bike Tour Registration Free for UTA Members (Bike tour fees are not included in the conference registration.)   Attendees   Attendees Attendees Attendees   For sponsorship information, click here     Sunday Golf Registration UTA Member @ $180 per attendee (Golf fees are not included in the conference registration.) $ Non-Member or Late Participant @ $200 per attendee (after October 7th) $ Attendees   Handicap Attendees Handicap Attendees Handicap Attendees Handicap   For sponsorship information, click here     Sunday Bowling Tournament Registration UTA Members @ $75 per attendee (Bowling fees are not included in the conference registration.) $ Non- Member or Late Participant @ $85 per attendee (after October 7th) $ Attendees   Attendees Attendees Attendees   For sponsorship information, click here Credit Card Information Check One:      MasterCard      Visa        Check Total Amount $: Card Number: 3 Digit Security Code at the back of the card (CCV): Expiration Date: Name on Card: Billing Address: City, State, Zip: Signature: _____________________________ Please mail to: United Trustees Association 2030 Main Street, Suite 1300 Irvine, CA  92614