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Conference Registration Form
February 6-9, 2012
Please fill the form out completely before submitting
We value your privacy, any information submitted within this form is for conference
purposes only and will not be viewed by, given or sold to any other parties.
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First Name
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Last Name
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Name as you would like it to appear on Nametag
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Institution / affiliation
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Position
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Phone
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Email
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Please select the dates you will be attending:
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Full Conference
(member) $175.00
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Full Conference
(non-member) $225.00
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February 7th
$75.00
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February 8th
$75.00
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February 9th
$75.00
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Will you be attending the post-conference workshop with Ken Ramirez?
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Yes
Additional $150.00
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No
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T-shirt size unisex/mens
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Select meals will be provided for attendees please select your diet preference:
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Do you have any other dietary restrictions or
preferences that we should be aware of?
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During the conference a silent auction will be
held to benefit the Giraffe Conservation
Foundation, attendees are encouraged to bring
an item/items to be donated for the auction, if
you are able to bring an item please describe:
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Would you like your email address added to our
mailing list for future news/events of the IAGCP?
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Yes
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No
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Please note - Registration submitted after January 15, 2012 is subject to a $50.00 late fee
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By submitting this form you agree to hold no liabilities against The International Association of
Giraffe Care Professionals, its trustees, members, sponsors, partners or hosts. You also
assume all responsibilities and risks related to participating in this conference or any of its
components.
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