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usrr <br />usrs <br />usrs <br />looms <br />u■ra <br />"0r` League of California Cities <br />City Council - City Manager Leadership Team Workshop <br />Wednesday - Friday, January 19-21, 2000 <br />Kellogg West Conference Center <br />Pomona <br />ADVANCE CONFERENCE REGISTRATION FORM <br />The City of <br />COLTON wishes to register 5 elected officials and the city manager. <br />The following officials have agreed to attend this workshop. (Please indicate titles as well as names) <br />City Manager: <br />(not attending- City Manas�YGarcia) <br />Mayor/Council Members 1 <br />JAMES B. GRIMSBY — attending <br />BETTY L. COOK -attending <br />2. <br />3 KELLY J. CHASTAIN —attendig <br />4, DEIRDRE H. BENNNETT — attending <br />5. RICHARD A. DELAROSA _ <br />(Three participants constitutes a minimum team. Substitutions may be made up to the start of the program.) <br />To help us plan for any special needs, please call the conference registration office at 925/283-2113 if any registrant requires special <br />accommodations for disabilities. <br />PAYMENT INFORMATION: Check which is enclosed (no purchase orders, American Express or Discover cards). Make <br />checks payable to League of California Cities. <br />XX City Check _Personal Check <br />VISA XX MasterCard (Deposit Onlyt,$1,000) <br />Deposit: $200 x 5 persons = $ 1,000 <br />Payment in full: $2,900 plus $700 per thy- Persons above minimum three attendee <br />Authorized Signature: ADELFA FLORES EXECUTIVE SECRETARY <br />Name on Credit Card: COL )N CITY CO[JN T� L Telephone: ( 9( <br />Credit Card Number: Expiration Date: <br />$ 4', <br />APRIL 2002 <br />We understand that space for this workshop is limited, and that other cities cannot be expected to clear their calendars to attend in our <br />place on short notice if we cancel. Therefore, we understand that we will forfeit either our non-refundable deposit of $200 per person <br />and our reserved spaces if we do not pay in full or cancel before the deadline; or we will forfeit our full registration fees except for <br />$250 per person if we cancel prior to four weeks prior to the start of the workshop. After this date we understand no refunds will be <br />possible because of contractual commitments. <br />MAYOR PRO TER bARl1 9, 1999 <br />Signature Deirdre H. Bennett Title Date <br />This form must be postmarked by the appropriate deadline: Wednesday, November 30, 1999 <br />Please mail to: <br />League of California Cities <br />P.O. Box 1519 <br />Lafayette, CA 94549 <br />925/283-2113 (For those paying with credit card ONLY, you may fax to 925/283-7833.) <br />