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Dixie Convention Center,
St. George, Utah
Registration Form
Please type or print and fill out completely
You may register online or mail registration form to:
UCLS, P.O. Box 1032, Salt Lake City, UT 84110
For more information or to register online: www.ucls.org
Fax/Phone: (801) 964-6192
Name:________________________________________ Name for Nametag__________________________
Company:____________________________________________________________________________
Mailing Address: _______________________________________________________________________
City: _______________________________________State/Zip:__________________________________
Phone: (
) _____________________________ Fax: (
) _____________________________
License Number:____________________________E-Mail: ________________________________________
Included with registration fees:
• All sessions for those days •Up to 17.5 PDH’s • Handouts & complimentary items • All breaks with exhibitors
• Lunches & Cont. Breakfast • Opportunity to socialize with peers • Installation banquet
UCLS Member Conference Registration Fees
Member Registration Full Conference
$375.00
$_______
Thursday and Friday only
$300.00
$_______
Friday only
$225.00
$_______
Non-Member Conference Registration Fees
Non-member Registrations Full Conference
$500.00
$_______
Thursday and Friday only
$400.00
$_______
Friday only
$300.00
$_______
Student Registration Full Conference (must provide student ID) $100.00
$_______
Optional Activities
Extra Banquet Ticket (per person)
$30.00
$_______
Surcharge for Late Registration
(after February 11, 2015)
$25.00
$_______
Grand Total ..................................................................................... $______
Check here if you require special service (please describe your needs in writing on a separate sheet of paper and enclose it with your registration)
Check here if you are interested in the OPUS Projects Training class - max. 30 people, first PLS members registered take priority, must bring your own laptop
Registration Deadline: February 11, 2015, 10:00 p.m. (MT)
Late registrants will not be guaranteed conference handouts.
No refunds will be given after
February 11, 2015. No exceptions.
UCLS accepts payment by check or credit card.
If paying by check, please make checks payable
to UCLS and send to the address above. Please
submit one registration form per attendee.
Partial funding for this educational opportunity may be
provided by the Utah Department of Commerce, Division
of Occupational and Professional Licensing and the Education Enforcement Fund.
Payment Information
Check Enclosed
MasterCard
Visa
Discover
American Express
Card Number_____________________________________________
Expiration Date __________________________________
Security Code____________
Signature_______________________________________________