The Fifth Annual Conference on Drugs,
Alcohol and Impaired Driving
June 27-29, 1999
Radisson Hotel South and Plaza Tower, Bloomington, Minnesota
Co-hosted by the IACP/DRE Section,
the National Highway Traffic Safety Administration (NHTSA),
and the Minnesota State Drug Evaluation Classification Program

For more information or to register, contact Carolyn Cockroft at 1-800-THE-IACP, or mail this form to:
Carolyn Cockroft, IACP, PO BOX 90976, Washington D.C. 20090-0976
To expedite the processing of your registration, please also fax a copy of your completed registration form to 1-800-836-4543, Attn: Juanita Ward.

 
Name (Rank/Title):_______________________________________________
 
Your function within the organization:__________________________________
 
Agency/Organization:_____________________________________________
 
Business Address: ______________________________________________
 
City: _________________________State:________Zip:______________
 
Telephone:(_____)_________________FAX:(_____)_____________________
 
Email: __________________________________________
 
Total preregistration fee
(accepted until June 1):$___________Payment enclosed?________
 
IACP#___________________
 
VISA#_______________________________
 
MasterCard#__________________________Expiration Date:_________
 
Check #___________________ Purchase Order # ____________________

If you plan to join any of the following events, indicate the number of persons in your party (for spouses and additional guests attending the banquet and reception, onsite fees may be charged):
 
 
6/26 Welcome reception: ______     6/29 Banquet: ______