EmailMe Form - 2018 CPS Update Registration

2018 CPS Update Registration
Complete this form to register for the 2018 CPS Technician Update. You MUST enter an email address to register with this form. (If you do not receive a confirmation of your registration within 5 working days, please resubmit)

Complete one registration form per participant and submit information.

Registration Deadline
March 9, 2018 for Nebraska CPS Technicians requesting lodging
April 3, 2018 for all other CPS Technicians

Your Name (First AND Last) *

Your Organization

Mailing address

City *

State *

Zip

Primary phone

Work phone

Fax number

Email (REQUIRED) *

Safe Kids Technician Number *

Lodging needs:
(*To determine mileage use www.mapquest.com “Directions”.)
*Nebraska Techs Only

I do not need lodging.

I will be traveling 100* miles (one way) and I will need lodging Tuesday, April 10, 2018.

I will make my own arrangements with Comfort Inn, 308-236-3400

Image Verification
	Please enter the text from the image: [Refresh Image] [What's This?]