2013 SEARCH Annual Membership Group Meeting

Attendee Information
Are you attending:	_____ Meetings only _____ Reception/Dinner only _____ Both Meetings and Reception/Dinner
Are you a:	_____ SEARCH Member _____ Alternate Member _____ Speaker _____ Observer _____ SEARCH Staff
Prefix	__________________________________________________
First Name*	__________________________________________________
Last Name*	__________________________________________________
First name as it should appear on badge	__________________________________________________
Title	__________________________________________________
Division/Section	__________________________________________________
Agency/Company*	__________________________________________________
Mailing Address*	__________________________________________________
	(Note: Please provide a street address. FedEx will not deliver to PO boxes.)
City*	__________________________________________________
State*	__________________________________________________
ZIP*	__________________________________________________
Business Phone*	__________________________________________________
	(with area code)
Cell Phone*	__________________________________________________
	(best phone to reach you)
Fax	__________________________________________________
Email*	__________________________________________________
Alternate Member _____ Yes, I am attending as a SEARCH Alternate Member on behalf of: ____________________________________ (NOTE: A proxy letter from your state's SEARCH representative confirming your participation as an Alternate is required. Please submit this letter to Nina Sullivan at nina@search.org or fax to 916-392-8440. Thank you!
New Member Orientation (Members Only)* I plan to attend the New Member Orientation Breakfast on Tuesday, July 23, at 7:30 a.m. (The New Member Orientation Breakfast is intended for new Members and first-time alternates; other Members are also welcome.) _____ Yes   _____ No
Awards Reception/Dinner I plan to attend the Awards Reception/Dinner on Tuesday, July 23, at 6 p.m. _____ Yes   _____ No If yes, are you bringing a guest? _____ Yes   _____ No Guest name: __________________________________________________