To attend the Roadside Conference, please complete the form below. Name of attendee (please fill out one registration form per person) Company/Organization Address City State Zip Email Address Work Phone Please note any special dietary requests/allergies Are you interested in playing in the AFIRM golf tourney the afternoon of Wednesday, September 7th? Yes No Maybe “Are you interested in participating in a fishing tournament the afternoon of Wednesday, September 7th? Yes No Maybe Please choose your registration level Registration (full): $95 (Includes Thursday AM refreshments and lunch, bus tour, evening banquet, Friday breakfast and lunch) One-Day Registration: $35 (For Thursday: includes AM refreshments, lunch, bus tour, evening banquet; for Friday: includes breakfast, lunch) Conference Exhibitor: $150 (Includes one table and one full registration) Complimentary Registration (For sponsors, speakers, and invited guests from counties interested in starting a roadside program) Leave this field blank