2014 SEARCH Winter Membership Group Meeting

Fax to 916-392-8440         *indicates mandatory fields
Attendee Information
Are you attending: _____ Meetings only
_____ Reception only
_____ Both Meetings and Reception

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, January 28, 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

Networking Reception
I plan to attend the Networking Reception on Tuesday, January 28, at 6 p.m.
_____ Yes   _____ No

If yes, are you bringing a guest?
_____ Yes   _____ No

Guest name: __________________________________________________

Special Needs?
Let us know if you have any special needs or requests (i.e. dietary, etc.).
__________________________________________________
__________________________________________________
__________________________________________________