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Eastern Division IAFC Annual Conference Registration
Antendee Information:
First Name
*
M. I.
Last Name
*
Suffix
Jr.
Sr.
II
III
IV
Street Address
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Address Line 2
City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
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Phone Number
*
Email Address
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Your Department Type:
*
Career
Volunteer
Combination
Which best identifies your current position?
*
Career
Volunteer
Active member of the IAFC?
*
Yes
No
Eastern Division State
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Delaware
District of Columbia
Maryland
New Jersey
New York
Pennsylvania
Other
County (Primary Agency)
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Allegany
Anne Arundel
Baltimore County
Baltimore City
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
District of Columbia
Federal Government
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince George's
Queen Anne's
Somerset
St. Mary's
State of Maryland
State of Virginia
Talbot
Washington
Wicomico
Worcester
Select Your Primary Agency Affiliation (Allegany)
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Allegany County Department of EMS
Baltimore Pike Volunteer Fire Department, Inc.
Barton Hose Company No. 1, Inc.
Bedford Road Volunteer Fire Department, Inc.
Bloomington Fire Company
Bowling Green Volunteer Fire Department, Inc.
Bowman's Addition Volunteer Fire Company, Inc.
Corriganville Volunteer Fire Company, Inc.
Cresaptown Volunteer Fire Department, Inc.
Cumberland Fire Department (Career Dept)
District 16 Volunteer Fire Department, Inc. (Cumberland)
Ellerslie Volunteer Fire Company, Inc.
Flintstone Volunteer Fire Company, Inc.
Frostburg Area Ambulance Service
Frostburg Fire Department, Inc.
George's Creek Ambulance Service, Inc.
Goodwill Fire Company No.1, Inc. (Lonaconing)
La Vale Volunteer Fire Department, Inc.
La Vale Volunteer Rescue Squad, Inc.
Luke Volunteer Fire Company, Inc.
Midland Volunteer Fire Department
Mount Savage Volunteer Fire Company No. 1, Inc.
Oldtown Volunteer Fire Department, Inc.
Orleans Volunteer Fire Department, Inc.
Potomac Fire Company No. 2, Inc. (Westernport)
Rawlings Volunteer Fire Department, Inc.
Shaft Volunteer Fire Company, Inc.
Tri Towns EMS, Inc.
Select Your Primary Agency Affiliation (Anne Arundel)
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Annapolis City Fire Department
Anne Arundel County Fire Department (Career Dept)
Arnold Volunteer Fire Department, Inc.
Arundel Volunteer Fire Department, Inc.
BWI Airport Fire & Rescue Department
Cape Saint Claire Volunteer Fire Company, Inc.
Deale Volunteer Fire Dept & Rescue Squad, Inc.
Earleigh Heights Volunteer Fire Company, Inc.
Ferndale Volunteer Fire Company, Inc.
Fort Meade Fire Department
Glen Burnie Volunteer Fire Company, Inc.
Herald Harbor Volunteer Fire Department, Inc.
Jessup Volunteer Fire Department, Inc.
Lake Shore Volunteer Fire Company, Inc.
Maryland City Volunteer Fire Department & Rescue Squad, Inc.
Odenton Volunteer Fire Company, Inc.
Orchard Beach Volunteer Fire Company, Inc.
Riviera Beach Volunteer Fire Company, Inc.
West Annapolis Fire and Improvement Company, Inc.
Woodland Beach Volunteer Fire Department, Inc.
Select Your Primary Agency Affiliation (Baltimore County)
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Arbutus Volunteer Fire Department, Inc.
Baltimore County Fire Department (Career Dept)
Bowley's Quarters Volunteer Fire Department
Butler Volunteer Fire Company, Inc.
Chestnut Ridge Volunteer Fire Company
Cockeysville Volunteer Fire Company, Inc.
English Consul Volunteer Fire Department
Glyndon Volunteer Fire Department
Hereford Volunteer Ambulance Association
Hereford Volunteer Fire Department
Essex Volunteer Fire Company
Jacksonville Volunteer Fire Company
Kingsville Volunteer Fire Company
Lansdowne Volunteer Fire Department
Liberty Road Volunteer Fire Company, Inc.
Long Green Volunteer Fire Company, Inc.
Lutherville Volunteer Fire Company
Maryland Line Volunteer Fire Company
Middle River Volunteer Fire & Rescue Company
North Point-Edgemere Volunteer Fire Department
Owings Mills Volunteer Fire Company, Inc.
Pikesville Volunteer Fire Company
Providence Volunteer Fire Company, Inc.
Reisterstown Volunteer Fire Company, Inc.
Rosedale Volunteer Fire Company, Inc.
Upperco Volunteer Fire Company
White Marsh Volunteer Fire Company
Wise Avenue Volunteer Fire Company, Inc.
Woodlawn Volunteer Fire Company, Inc.
Select Your Primary Agency Affiliation (Baltimore City)
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Baltimore City Fire Department
Select Your Primary Agency Affiliation (Calvert)
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Calvert County Advanced Life Support, Inc. (Mobile ICU)
Calvert County Fire-Rescue-EMS Division
Dunkirk Volunteer Fire Department & Rescue Squad
Huntingtown Volunteer Fire Department & Rescue Squad, Inc.
North Beach Volunteer Fire Department, Inc.
Prince Frederick Volunteer Fire Department, Inc.
Prince Frederick Volunteer Rescue Squad, Inc.
Solomons Volunteer Rescue Squad and Fire Department, Inc.
St Leonard Volunteer Fire Department & Rescue Squad, Inc.
Select Your Primary Agency Affiliation (Caroline)
*
Caroline County Emergency Medical Services
Denton Volunteer Fire Company, Inc.
Federalsburg Volunteer Fire Company, Inc.
Goldsboro Volunteer Fire Company, Inc.
Greensboro Volunteer Fire Company
Marydel Volunteer Fire Company, Inc.
Preston Volunteer Fire Company, Inc.
Ridgely Volunteer Fire Department, Inc.
Select Your Primary Agency Affiliation (Carroll)
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Carroll County Emergency Services
Gamber and Community Fire Company
Hampstead Volunteer Fire Engine & Hose Company No. 1
Harney Volunteer Fire Company
Lineboro Volunteer Fire Department, Inc.
Manchester Volunteer Fire Department and Hook & Ladder Co. No. 1
Mount Airy Volunteer Fire Company, Inc.
New Windsor Fire & Hose Company No. 1
Pleasant Valley Community Fire Company, Inc.
Reese & Community Volunteer Fire Company, Inc.
Sykesville-Freedom District Fire Department, Inc.
Taneytown Volunteer Fire Company
Union Bridge Fire Company, Inc.
Westminster Fire Engine & Hose Company No. 1
Winfield Community Volunteer Fire Department, Inc.
Select Your Primary Agency Affiliation (Cecil)
*
Cecil County Department of Emergency Services
Cecilton Volunteer Fire Company, Inc.
Charlestown Fire Company, Inc.
Chesapeake City, Inc., Volunteer Fire Company No. 1 of
Community Fire Company of Perryville, Inc.
Community Fire Company of Rising Sun, Inc.
Hacks Point Fire Company, Inc.
North East Fire Company, Inc.
Singerly, Wm. M., Steam Fire Engine & Hook & Ladder Company No.1 (Elkton)
Water Witch Fire Company, Inc.
Select Your Primary Agency Affiliation (Charles)
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Bel Alton Volunteer Fire Department, Inc.
Benedict Volunteer Fire Department & Rescue Squad, Inc.
Bryans Road Volunteer Fire Department & Rescue Squad, Inc.
Charles County Emergency Medical Services
Charles County Volunteer Rescue Squad
Cobb Island Volunteer Fire Department & EMS, Inc.
Dentsville Volunteer EMS & Auxiliary Inc.
Hughesville Volunteer Fire Dept. & EMS, Inc.
Indian Head Volunteer Fire Department, Inc.
Ironsides Volunteer Rescue Squad
La Plata Volunteer Fire Department, Inc.
Nanjemoy Volunteer Fire Department
Newburg Volunteer Rescue Squad and Fire Department
Potomac Heights Volunteer Fire Department & Rescue Squad, Inc.
Tenth District Volunteer Fire Department, Inc. (Marbury)
Waldorf Volunteer Fire Department, Inc. Sta. 3
Select Your Primary Agency Affiliation (District of Columbia)
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District of Columbia Fire & EMS
Select Your Primary Agency Affiliation (Dorchester)
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Church Creek Volunteer Fire Company, Inc.
Dorchester County Emergency Medical Services
East New Market Volunteer Fire Company, Inc.
Eldorado-Brookview Volunteer Fire Company
Elliott Island Volunteer Fire Company
Hooper's Island Volunteer Fire Company
Hurlock Volunteer Fire Company
Lakes & Straits Volunteer Fire Company, Inc.
Linkwood-Salem Volunteer Fire Company
Madison Volunteer Fire Company, Inc.
Neck District Volunteer Fire Company, Inc.
Rescue Fire Company, Inc. (Cambridge)
Secretary Volunteer Fire Company, Inc.
Taylors Island Volunteer Fire Company, Inc.
Vienna Volunteer Fire Company, Inc.
Select Your Primary Agency Affiliation (Federal Government)
*
Aberdeen Proving Ground
Fort Meade
Fort Detrick
Naval District Washington Fire & Emergency Department
NIH
NIST
Select Your Primary Agency Affiliation (Frederick)
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Braddock Heights Volunteer Fire Company, Inc.
Brunswick Volunteer Ambulance Company
Brunswick Volunteer Fire Company
Carroll Manor Fire Company, Inc. (Adamstown)
Citizens Truck Company No. 4 (Frederick)
Emmitsburg Community Ambulance
Fort Detrick Fire Department
Frederick County Division of Fire and Rescue Services (Career)
Graceham Volunteer Fire Company, Inc.
Guardian Hose Company, Inc. (Thurmont)
Independent Hose Company No. 1 (Frederick)
Jefferson Volunteer Fire Company, Inc.
Junior Fire Company No. 2
Lewistown District Volunteer Fire Dept, Inc.
Libertytown Volunteer Fire Department, Inc.
Middletown Volunteer Fire Company, Inc.
Myersville Volunteer Fire & Rescue Company, Inc.
New Market District Volunteer Fire Department
New Midway Volunteer Fire Company, Inc.
Rocky Ridge Volunteer Fire Company, Inc.
Thurmont Community Ambulance Service
United Steam Fire Engine Company No. 3
Urbana Volunteer Fire Department, Inc.
Vigilant Hose Company, Inc. (Emmitsburg)
Walkersville Volunteer Fire Company, Inc.
Walkersville Volunteer Rescue Company, Inc.
Wolfsville Volunteer Fire Company, Inc.
Woodsboro Volunteer Fire Company, Inc.
Select Your Primary Agency Affiliation (Garrett)
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Accident Volunteer Fire Department, Inc.
Bittinger Volunteer Fire Department, Inc.
Deep Creek Volunteer Fire Company, Inc.
Deer Park Volunteer Fire Department, Inc.
Eastern Garrett County Volunteer Fire Company
Friendsville Volunteeer Fire and Rescue Department, Inc.
Garrett County Department of Public Safety
Gorman Volunteer Fire Department, Inc.
Grantsville Volunteer Fire Department, Inc.
Kitzmiller Volunteer Fire Department
Northern Garrett County Rescue Squad
Oakland Volunteer Fire Department, Inc.
Southern Garrett County Rescue Squad
Select Your Primary Agency Affiliation (Harford)
*
Aberdeen Fire Department, Inc.
Aberdeen Proving Ground Fire & Emergency Services
Abingdon Fire Company, Inc.
Bel Air Volunteer Fire Company, Inc.
Darlington Volunteer Fire Company, Inc.
Fallston Volunteer Fire & Ambulance Company, Inc.
Harford County Volunteer Fire and EMS Foundation
Havre De Grace Ambulance Corps. Inc.
Jarrettsville Volunteer Fire Company, Inc.
Joppa-Magnolia Volunteer Fire Company, Inc.
Level Volunteer Fire Company, Inc.
Norrisville Volunteer Fire Company
Susquehanna Hose Company, Inc. (Havre De Grace)
Whiteford Fire Department
Select Your Primary Agency Affiliation (Howard)
*
Elkridge Volunteer Fire Department, Inc.
Ellicott City Volunteer Firemen's Association
Fifth District Volunteer Fire Department, Inc. (Clarksville)
Howard County Department of Fire And Rescue (Career)
Lisbon Volunteer Fire Company, Inc.
Savage Volunteer Fire Company, Inc.
West Friendship Volunteer Firemen's Association, Inc.
Select Your Primary Agency Affiliation (Kent)
*
Betterton Volunteer Fire Company, Inc.
Chestertown Volunteer Fire Company, Inc.
Community Fire Company, Inc. of Millington
Galena Volunteer Fire Company, Inc.
Kennedyville Volunteer Fire Company, Inc.
Rock Hall Volunteer Fire Company, Inc.
Select Your Primary Agency Affiliation (Montgomery)
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Bethesda Fire Department, Inc.
Bethesda-Chevy Chase Rescue Squad, Inc.
Burtonsville Volunteer Fire Department, Inc.
Cabin John Volunteer Fire Department
Damascus Volunteer Fire Department, Inc.
Gaithersburg-Washington Grove Fire Dept., Inc.
Germantown Volunteer Fire Department Inc.
Glen Echo Fire Department
Hillandale Volunteer Fire Department, Inc.
Hyattstown Volunteer Fire Department, Inc.
Kensington Volunteer Fire Department, Inc.
Laytonsville District Volunteer Fire Department, Inc.
Montgomery County Fire & Rescue Service (Career)
Rockville Volunteer Fire Department, Inc.
Sandy Spring Volunteer Fire Department, Inc.
Silver Spring Volunteer Fire Department, Inc.
Takoma Park Volunteer Fire Department, Inc.
Upper Montgomery County Volunteer Fire Department, Inc.
Wheaton Volunteer Rescue Squad, Inc.
Select Your Primary Agency Affiliation (State of Maryland)
*
Maryland State Fire Marshal's Office
Maryland Dept. of the Environemt
Select Your Primary Agency Affiliation (Prince George's)
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Accokeek Volunteer Fire Department, Inc.
Allentown Road Volunteer Fire Department, Inc.
Baden Volunteer Fire Department, Inc.
Beltsville Volunteer Fire Department, Inc.
Berwyn Heights Volunteer Fire Dept. & Rescue Squad, Inc.
Bladensburg Volunteer Fire Department & Rescue Squad, Inc.
Boulevard Heights Volunteer Fire & Rescue Department, Inc.
Bowie Volunteer Fire Department & Rescue Squad, Inc.
Branchville Volunteer Fire Company & Rescue Squad, Inc.
Brandywine Volunteer Fire Department & Rescue Squad
Brentwood Volunteer Fire Department, Inc.
Bunker Hill Volunteer Fire & Rescue Co., Inc. (Co 55)
Capitol Heights Volunteer Fire Department
Chapel Oaks Volunteer Fire Department Sta. 38
Chillum-Adelphi Volunteer Fire Department, Inc. Sta. 34
Clinton Volunteer Fire Department, Inc.
College Park Volunteer Fire Department, Inc.
District Heights Volunteer Fire Department, Inc.
Forestville Volunteer Fire Department, Inc.
Glenn Dale Fire Association, Inc.
Greenbelt Volunteer Fire Department & Rescue Squad, Inc.
Hyattsville Volunteer Fire Department, Inc.
Kentland Volunteer Fire Department & Rescue Squad
Landover Hills Volunteer Fire Department, Inc.
Laurel Volunteer Fire Department, Inc.
Laurel Volunteer Rescue Squad, Inc.
Marlboro Volunteer Fire Department, Inc.
Morningside Volunteer Fire Department, Inc.
Oxon Hill Volunteer Fire Department & Rescue Squad
Prince George's County Fire & EMS Department (Career)
Prince George’s County Volunteer Marine Fire-Rescue
Ritchie Volunteer Fire Department
Riverdale Fire Department, Inc.
Riverdale Heights Volunteer Fire Department, Inc.
Seat Pleasant Volunteer Fire Company, Inc.
Silver Hill Volunteer Fire Department & Rescue Squad, Inc.
West Lanham Hills Volunteer Fire Department
Select Your Primary Agency Affiliation (Queen Anne's)
*
Church Hill Volunteer Fire Company, Inc.
Crumpton Volunteer Fire Department
Goodwill Volunteer Fire Company, Inc. (Centreville)
Grasonville Volunteer Fire Department, Inc.
Kent Island Volunteer Fire Department, Inc.
Kent-Queen Anne's Rescue Squad
Queen Anne's County Department of Emergency Services
Queenstown Volunteer Fire Company, Inc.
Sudlersville Volunteer Fire Department, Inc.
United Communities Volunteer Fire Department
Select Your Primary Agency Affiliation (Somerset)
*
Crisfield Volunteer Fire Department
Deal Island-Chance Volunteer Fire Company, Inc.
Ewell Volunteer Fire Company, Inc.
Fairmount Volunteer Fire Company
Lower Somerset County Ambulance & Rescue Squad Inc
Marion Volunteer Fire Department
Mount Vernon Volunteer Fire Company
Princess Anne Volunteer Fire Company, Inc.
Tylerton Volunteer Fire Company
Select Your Primary Agency Affiliation (St. Mary's)
*
Bay District Volunteer Fire Department, Inc. (Station 3)
Hollywood Volunteer Fire Department, Inc.
Hollywood Volunteer Rescue Squad
Leonardtown Volunteer Fire Department, Inc.
Leonardtown Volunteer Rescue Squad
Lexington Park Volunteer Rescue Squad
Mechanicsville Volunteer Fire Department, Inc.
Mechanicsville Volunteer Rescue Squad
Ridge Volunteer Fire Department, Inc.
Ridge Volunteer Rescue Squad
Second District Volunteer Fire Department & Rescue Squad (Valley Lee)
Seventh District Volunteer Fire Department, Inc. (Avenue)
Seventh District Volunteer Rescue Squad
St Mary's Advanced Life Support
Select Your Primary Agency Affiliation (Talbot)
*
Cordova Volunteer Firemen's Association, Inc.
Easton Volunteer Fire Department, Inc.
Oxford Fire Company, Inc.
Queen Anne-Hillsboro Volunteer Fire Company
Saint Michael's Volunteer Fire Department
Talbot County Advanced Life Support
Tilghman Volunteer Fire Department
Trappe Volunteer Fire Company
Select Your Primary Agency Affiliation (Washington)
*
Antietam Fire Company, Inc. No. 2 (Hagerstown)
Boonsboro Ambulance and Rescue Service, Inc.
Clear Spring Ambulance Club
Clear Spring Volunteer Fire Company, Inc.
Community Rescue Service, Inc. (Hagerstown)
Community Volunteer Fire Company District 12, Inc. (Fairplay)
First Hagerstown Hose Company
First Hose & Rescue Company of Boonsboro, Inc.
Funkstown Volunteer Fire Company
Hagerstown Fire Department
Halfway, Volunteer Fire Company of
Hancock Rescue Squad
Hancock Volunteer Fire Company, Inc.
Independent Junior Fire Company No. 3 (Hagerstown)
Leitersburg Volunteer Fire Company, Inc.
Longmeadow Volunteer Fire Company, Inc.
Maugansville Goodwill Volunteer Fire Company
Mount Aetna Volunteer Fire Department, Inc.
Pioneer Hook & Ladder Company No. 1 (Hagerstown)
Potomac Valley Fire Company
Sharpsburg Rescue Squad
Sharpsburg Volunteer Fire Company
Smithsburg Community Volunteer Fire Department
Smithsburg Emergency Medical Services
South Hagerstown Fire Company No. 5
Washington County Division of Emergency Services
Washington County Special Operations
Washington County Volunteer Fire Rescue Association
Western Enterprise Fire Engine Company, Inc. No.4
Williamsport Volunteer Fire and EMS Company, Inc.
Select Your Primary Agency Affiliation (Wicomico)
*
Allen Volunteer Fire Company, Inc.
Delmar Fire Department, Inc.
Fruitland Volunteer Fire Company
Hebron Volunteer Fire Department, Inc.
Mardela Springs Volunteer Fire Company, Inc.
Parsonsburg Volunteer Fire Company, Inc.
Pittsville Volunteer Fire Department
Powellville Volunteer Fire Company, Inc.
Salisbury Fire Department Company No. 1
Salisbury Fire Department, Inc. (Headquarters)
Sharptown Fire Department, Inc.
Snow Hill Volunteer Fire Company, Inc.
West Side Volunteer Fire Department (Bivalve)
Willards Volunteer Fire Company
Select Your Primary Agency Affiliation (Worcester)
*
Berlin Fire Department, Inc.
Bishopville Volunteer Fire Department, Inc.
Girdletree Volunteer Fire Company, Inc.
Newark Volunteer Fire Company, Inc.
Ocean City Fire Department
Ocean Pines Volunteer Fire Department, Inc.
Pocomoke City EMS
Pocomoke City Volunteer Fire Company
Showell Volunteer Fire Department, Inc.
Stockton Volunteer Fire Company, Inc.
Name of Chief Officer
*
Agency Phone Number
*
Current Position
*
EMR
EMT
EMT-I
Paramedic
Firefighter
Firefighter/EMR
Firefighter/EMT
Firefighter/EMT-I
Firefighter/Paramedic
Driver/Operator/Engineer
Chief - Fire
Chief - EMS
Assistant Chief - Fire
Assistant Chief - EMS
Division/Deputy Chief - Fire
Division/Deputy Chief - EMS
Battalion Chief - Fire
Battalion Chief - EMS
Captain - Fire
Captain - EMS
Lieutenant - Fire
Lieutenant - EMS
Sergeant - Fire
Sergeant - EMS
Chaplain
Other
Registration Options
Options
*
Full Conference $175
Saturday Night Installation Dinner
*
No Saturday Night Installation Dinner Guests
Saturday Night Installation Dinner - 1 Guest $75
Saturday Night Installation Dinner - 2 Guests $150
Saturday Night Installation Dinner - 3 Guests $225
Saturday Night Installation Dinner - 4 Guests $300
Saturday Night Installation Dinner - 5 Guests $375
Partners Program
*
No Partners
Partners Program Getaway (Spouses/Family Members) - 1 Partner $45
Partners Program Getaway (Spouses/Family Members) - 2 Partners $90
Partners Program Getaway (Spouses/Family Members) - 3 Partners $135
Partners Program Getaway (Spouses/Family Members) - 4 Partners $180
Partners Program Getaway (Spouses/Family Members) - 5 Partners $225
Options
*
Lunch Meals $50 (Must purchase to attend conference)
Saturday Night Installation Dinner (Maryland conference attendees must pay for themselves and guest(s) to attend dinner installation)
*
Saturday Night Installation Dinner - Conference Attendee
I do not plan on attending the Saturday Night Installation Dinner
No Saturday Night Installation Dinner Guests
Saturday Night Installation Dinner - 1 Guest $75
Saturday Night Installation Dinner - 2 Guests $150
Saturday Night Installation Dinner - 3 Guests $225
Saturday Night Installation Dinner - 4 Guests $300
Saturday Night Installation Dinner - 5 Guests $375
Partners Program
*
No Partners
Partners Program Getaway (Spouses/Family Members) - 1 Partner $45
Partners Program Getaway (Spouses/Family Members) - 2 Partners $90
Partners Program Getaway (Spouses/Family Members) - 3 Partners $135
Partners Program Getaway (Spouses/Family Members) - 4 Partners $180
Partners Program Getaway (Spouses/Family Members) - 5 Partners $225
Maryland Fire Service Member Code?
*
Payment Information
Credit Card Type
*
Visa
Mastercard
Discover
American Express
Name on Credit Card
*
Card Number
*
Expiration Date
*
CV Code (3 Digit Security Code)
*
Credit Card Billing Zip Code
*
Email Address for Receipt
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Registration Confirmation
Registration Verification
*
By submitting this form, I acknowledge that I am registering for the Eastern Division IAFC Annual Conference to be held in Ocean City, Maryland on April 21, 2023 & April 22, 2023.
I understand that any cancellation must be provided in writing to psterling@ediafc.com. Cancellations will not be excepted within 30 days of the conference.
Signature of individual completing conference registration.
*
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