Georgia Utilities Coordinating Council

Your Information

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First Name ^*	Last Name ^*
Job Title ^*
Company ^*
Address ^*
City ^*
State ^*	ZIP ^*
Phone Number ^*	Cell Number
Email ^*

Conference Information First time attending? ^* YES    NO
Are you a Retired Life Member? ^* YES    NO
Are you a local chairman? ^* YES    NO
Are you a Regional Director? ^* YES    NO
If yes, will you be attending the Chairman & Regional Director's Breakfast? ^* YES    NO

Type of Registration

Full Registration ($250)
Spouse/Child Registration ($60)

Note: If you register AFTER 3/16/12, there will be an additional $50 fee. Full Registration will be $300. Spouse/Child Registration includes Thursday dinner only.

Golf Information Would you like to register for the Golf Tournament? ^* YES NO

Your Average Score ^*
Would you like to be paired with someone? ^* YES NO

First Name ^*	Last Name ^*
Company ^*
Email ^*
Phone Number ^*
Average Score ^*
Will you be paying for this player? ^* YES NO

Type of Registration

Your Registration Type ^* Registered Conference Attendee ($110)
Non-Registered Players ($160) ¹

Pair Registration Type ^* Registered Conference Attendee ($110)
Non-Registered Players ($160) ¹

¹ Note: Includes Awards Banquet dinner on Thursday night.

Total Cost

I have read and agree to the cancellation policy. ^*