2015 Mayors Conference Registration

1. Please provide the following:

First Name

Last Name

Title

Organization

Street Address

Apt/Suite/Office

City

State

Zip

Email Address

Phone Number

Mobile Phone

2. Name as it should appear on badge

If you would like an assistant to be copied on email communications:

3. Assistant's Name

4. Assistant's Email

5. Assistant's Phone

6. Special hotel requests (may result in charge to participant):

7. Special dietary requests for conference: