CHIEF Grants Seminar

CHIEF Grants Secure Online Seminar Registration

Step 1 of 5 - Seminar & Host Department/Agency
Name of Host Department/Agency:

Step 2 of 5 - Your Department/ Agency Info
Choose your industry:
Department/Agency Name:
Billing Address:

City:
State:
Zip Code:

Step 3 of 5 - Your Contact Info
	Check the box if you are attending the seminar
First Name:
Last Name:
Rank/Title:
Phone:
Fax:
E-mail:
How did you learn about CHIEF Grants Seminars?

Step 4 of 5 - Register Students
1) Rank & Name:
2) Rank & Name:
3) Rank & Name:

Step 5 of 5 - Payment Method
Cost: $349 per attendee (Early Birds save! Only $299 when booking up to 30 days in advance) Select Payment Method

Credit Card (Your available credit will be reduced by amount of registration dues, but your account will not be charged until the time of the seminar) Online payment: fill out the secure order form below Check (Full payment must be received by the first day of the seminar) Pay to 'CHIEF' Purchase Order (Full payment must be received by the first day of the seminar) Enter your P.O. number My CHIEF Account (Your standard account terms apply) Enter your account number

Secure Online Credit Card Payment
Credit Card Type
Name On Card:
Credit Card Number:
Credit Card Security Code:	What is this?
Expiration Date (mm/yy):
Check here if Billing Address is same address as entered in Step 1:
Credit Card Billing Address:
Credit Card City:
Credit Card State:
Credit Card Zip Code:

Review all details above before pressing "Submit". Inaccurate information will delay processing of your registration.