California State Coroners' Association
REGISTRATION FORM - 2018
Annual Fall Training Symposium
Sunday, September 16 - Friday noon, September 21, 2018
The Flamingo Hotel, Santa Rosa, CA

Bold = required field

Last:  First:  Middle: 

Office Address:  City:        P.O.S.T. ID#:   

Zip:   County:   Phone:  

E-Mail Address:      Member: (With Dues Paid): Yes   No

Are You A Public Safety Member:   Yes   No Retired?   Yes   No
(Some classes may not be available to non-public safety members)
NOTE - P.O.S.T. CREDIT IS GIVEN FOR WEEKLY REGISTRATION FEE 32 HOUR+BLOCK ONLY
FULL WEEK REGISTRATION
Registration Fee - Full Week
Members Non-Members
Before
8/10/18
After
8/10/18
Before
8/10/18
After
8/10/18
$295
$325
$350
$375
Your full week registration fee includes three complimentary meals shown below. If you are bringing a guest who is not paying the full week registration fee, you may purchase their meals separately. All guest meals must be purchased in advance.
Meals - Indicate Attendance Below*
Monday Vendor Cocktails $  Free
 
Tuesday Luncheon # X $35/meal
Tuesday Night Dinner @ Sazon's Restaurant # X $65/meal
Banquet # X $65/meal
Tuesday Luncheon     $  Free
 
Tuesday Night Dinner @ Sazon's Restaurant     $  Free
 
Wednesday Banquet     $  Free
 
Pre-Paid Daily Breakfast Buffet
(Includes tax & tip)
# of days X $10/daily
 
Purchase Meals for Your Guests Here
Tuesday Luncheon # of Guests X $35/meal
Tuesday Dinner # of Guests X $65/meal
Wednesday Banquet # of Guests X $65/meal
Meal Total
 
Banquet Menu

Full week registration complimentary meal choice
(select one)
Write the number of guest meals selected in the box below (purchased meals)
  Baked Pork Loins
  Breaded Chicken Breast
  Baked Salmon
 
Total Symposium Fees   
Pay to CSCA Executive Secretary
 
PER DAY REGISTRATION
Registration Fee - Per Day
Members Non-Members Registration fees must be paid by August 14th to receive a training notebook
Before
8/10/18

After
8/10/18

Before
8/10/18

After
8/10/18

$110
$135
$175
$200
 
Register for Specific Days
 
Monday   Tuesday  Wednesday  Thursday  Friday

Number
of Days
X
Per Day
Fee

TOTAL FEE
 
Meals are not included in the per day registration fees. Meals may be purchased separately.
All meals must be purchased in advance.
 
Purchase Your Meals Here
Pre-Paid Daily Breakfast Buffet
(Includes tax & tip)
# of days X $10/daily
Tuesday Luncheon # of meals X $35/meal
Tuesday Dinner @ Sazon's Restaurant # of meals X $65/meal
Wednesday Banquet # of meals X $65/meal
Meal Total
 
Banquet Menu

Per Day registration
banquet meal choice purchased above
Write number of meals purchased for banquet
Baked Pork Loins
Breaded Chicken Breast
Baked Salmon
 
Total Symposium Fees   
Pay to CSCA Executive Secretary
 
*I will attend the Vendor Cocktail Reception on Monday evening  Yes       No
*I will attend the Luncheon on Tuesday (sandwich and salad bar)  Yes       No
*I will attend the Dinner @ Sazon's Restaurant on Tuesday Evening  Yes       No
*I will attend the Banquet on Wednesday Evening  Yes       No

CALIFORNIA STATE CORONERS' ASSOCIATION REGISTRATION CANCELLATION POLICY
Cancel your Registration by 8/1/18 and you will be reimbursed.
Cancel your Registration after 8/1/18 and you will not be reimbursed.
All refunds will be subject to a $ 25.00 Administrative fee.

MAKE CHECKS PAYABLE TO CSCA. MASTER CARD & VISA CAN BE ACCEPTED FOR PAYMENT – CALL (530) 870-8743.
MAIL CHECK AND FORM TO: Gary D. Tindel, CSCA EXECUTIVE SECRETARY 1947 Heidi Way, Yuba City, CA 95993
PLEASE USE SEPARATE FORM FOR EACH REGISTRANT (Photocopy ok)