North Carolina D.A.R.E. Officers Association

20^th Annual D.A.R.E. Conference

“Wave Good Bye to Drugs”

January 12-16, 2009

Sheraton Hotel

Atlantic Beach, North Carolina

 

Full Name:  _____________________________________________________________

Title:  __________________________________________________________________ 

Name (As you want it to appear on your NCDOA card):  __________________________

Department or School:  ________________________________ County:  ____________

Mailing Address: ________________________ City: _______________, NC Zip: _____

Work Phone:   (        ) ______-__________

Home Phone:  (        ) ______-__________

Cell Phone:     (        ) ______-__________

Email Adress:_____________________________@_____________________________

Last four digits of Social Security Number: xxx-xx-_________

 

Registration includes all workshops, one luncheon, one banquet, and NCDOA membership for one year, membership card, goody bag and newsletter.

REGISTRATION FEE PRIOR TO DECEMBER 19, 2008        $ 135.00

REGISTRATION FEE AFTER DECEMBER 19, 2008             $ 150.00

SPOUSE REGISTRATION FEE                                                 $ 65.00

PLEASE MAKE CHECKS PAYABLE TO NCDOA AND MAIL TO:

Deputy Traci Williams (Treasurer)

Randolph County Sheriff’s Office

727 McDowell Rd.

Asheboro, N.C. 27205

Spouse Registration Information

Name:  ____________________