Safe Trucking Board Meeting Registration

August 21-24, 2016

Your name for name badge*
First Last
Spouse/Guest name for name badge
First Last
PLEASE USE SPOUSE/GUEST FOR SPOUSE OR SIGNIFICANT OTHER ONLY. OTHER ATTENDEES FROM YOUR COMPANY NEED TO SUBMIT THEIR OWN ONLINE REGISTRATION.
Others/children-names and ages

IF YOU ARE BRINGING CHILDREN, PLEASE PROVIDE NAME AND AGE OF EACH CHILD.
Company Name*
Phone*
Email*

PLEASE CHECK TO BE SURE THE EMAIL ADDRESS YOU ENTERED ABOVE IS ACCURATE OR YOU WON'T RECEIVE YOUR EMAIL CONFIRMATION.
Arrival date:*
Month
Day
Year
Departure date:*
Month
Day
Year
Fairmont President's Club #
Any allergies or special diet?
Any hotel room preferences?
Emergency Contact and Phone #*
Please indicate board book preference:*
- Electronic
- Paper Copy
As we continue our efforts to move toward electronic board books, please change the above selection to Paper if you still wish to receive a hard copy board book.