A-ONE, Inc. 20th Annual Training Conference
August 4th - August 7th, 2008.

Pre-Registration Form

(Please Print or Type)

Last Name: __________________________First Name:______________________Middle Initial:____

Date of Birth:________________________ SSN:_____________________ Male: ____ Female: ____

Signature: _______________________________________

(Check One)
____Certified Law Enforcement Officer (Active).....Agency: _____________________________

____Retired Law Enforcement Officer...................Agency: ______________________________

____Prosecuting Attorney......................................Agency: _________________________________

____Other (Agency & Details of Employment:_________________________________________

Mailing Address:_____________________________________ City:___________________

State:____________ Zip:________ Telephone Number:(_____)___________ Fax:(_____)____________

Zip Code________Phone:( ____ )_________Fax:( ____)___________E-mail______________________________

____New Member

____Renewal		 (Circle One)
Region I..........Region II..........Region III
Region IV..........Region V..........Out of State

Preregistration
Members - $200.00

Registration At The Door
Members - $225.00

METHOD OF PAYMENT Cash$________Check#_________P.O. #_________________

Mail Registration Form to:

A-ONE, Inc.
P.O. Box 247
Guthrie, Oklahoma 73044