Registration Form

To Register, please print and mail or fax (one per person).

Name, Title	___________________________________________________________________________
Agency	___________________________________________________________________________
Address	___________________________________________________________________________
City	________________	State	____	Zip	__________
Telephone	(_____)______________		Email	_____________________

*Payment enclosed for (please check amount): ___ $110 (must be received by 1/16/15) OR ___$140 (if received after 1/16/15)
I will attend (please check in front of city): ___ SACRAMENTO ___ OAKLAND ___ LOS ANGELES ___ SAN DIEGO

For vegetarian meal, specify: ___ YES or ___ NO
Other Comments: __________________

No refunds after January 16, 2015.

*Purchase orders, checks and money orders accepted. Please return registration forms for each attendee with payment to:
On the Capitol Doorstep; P.O. Box 73601; Davis, CA 95617. Phone: (530) 297-5420; fax: (530) 297-5420.

Make checks payable to: On the Capitol Doorstep.

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**All email addresses end @otcdkids.com

This page last updated 10/28/14.