31st Annual National Gang Violence Conference Registration Form

31st Annual National Gang Violence Conference

July 10 - 14, 2023 (July 10, 2023, is an optional training date)
Send confirmation to:*
Email
Attendee's Name*

First NameLast Name
Middle Name
Job Title/Rank*
Department Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Agency Phone *
Attendee's Cell Number*
Fax Number
Attendee's Department Email Address*
Please note: each registrant must have his or her own unique email address. A space for the training coordinator's email address is provided below, and those do not have to be unique.
Registration Information
Registrant Type*
Registration Comments
Agency Information
Agency/Organization*
Agency Type
Division/ Station
Unit/Assignment*
Note: California POST Number is required for POST credit.
California POST ID
State and Bar # (For Prosecutors)
Job Description
Job Status*
Training Coordinator
or Contact, if organized by someone other than a training coordinator
T/C Email
or Contact email
T/C Phone Number
Billing Contact*
Include name and best way to contact (phone #, email)
Fees and Payment Information
Conference Options

Conference Fee - Members ($400)Conference Fee - Non-Members ($425)Staff Registration (Free)
We will not establish a waitlist.

Registrations not paid in full by June 30, 2023, are subject to being bumped by a paid conference submission.

Current members attended the 2022 conference or have paid $25 dues in 2022 or 2023.

*Membership is vetted*
Expected Method of Payment

CheckPurchase OrderMoney OrderCredit CardPayment ForthcomingStaff Registration
PO/Check/Money Order#
If known
Send Purchase Orders, Check, or Money Order to the following:

Mail: 5904-A Warner Avenue, #331, Huntington Beach, CA 92649

Attention: Conference Registration

Email: rbanuelos@cgianet.com

Phone: (562) 713-2668
Additional Comments
If you select Credit Card, you can enter your credit card info here for processing. If you want to pay later, select Payment Forthcoming, and print the form if you want a copy.
Calculation

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Credit Card Information

Thank you for registering for the 31st Annual National Gang Violence Conference. A confirmation email will be June 19, 2023. Please make sure to check your spam/junk folders if you don't locate it in your primary inbox.
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31st Annual National Gang Violence Conference

Registration Information

Agency Information

Fees and Payment Information

Credit Card Information