Vendor Registration Form
Colorado Coroners Association 27th Annual 3-Day Practical Medico-legal Death Investigation Training Course Wednesday June 3rd through Friday, June 5th, 2015 DoubleTree Hotel, Colorado Springs 1775 E Cheyenne Mountain Blvd Colorado Springs, CO 80906 VENDOR REGISTRATION FORM Name: Title: Department: _______________________ Phone: Email: All registrations include lunch daily and am/pm snack and banquet Vendor Registration fee: Additional Guest at Banquet $400.00/person $ 40.00/person Total 20 Continuing Education and POST hours Please Register by May 15, 2015 Make checks payable to Colorado Coroners Association Mail completed form and check to: Colorado Coroners Association P.O. Box 164 Kiowa, Colorado 80117 To use a credit card: Fax registration to: 303-646-0446 Card # ____________ Billing Zip Code: Exp Date: __Verification # __ (3 digits from back of card) Questions: Jenny Howe (970) 628-5151, Fax (720) 204-6907 Email: [email protected] DoubleTree Reservations: 719-576-8900 Room Block Code: CCA Room Rate $104.00/night Book by May 03, 2015 http://doubletree.hilton.com/en/dt/groups/personalized/C/COSP-DT-CCA20150602/index.jhtml?WT.mc_id=POG
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