 |
|
|
Contact Information |
 |
Please complete the fields below. A red asterisk (*) indicates a required field.
|
Use the buttons at the bottom of the page or the menu bar to the left to move between screens, as using your browser buttons to return or advance to a page will cause you to lose everything you have already entered.
|
|
When returning from visiting a link off of the registration pages use your browser refresh button to retrieve your information. |
|
|
Please note that only credit cards are being accepted for payment of online registration. Have your credit card available when completing your online registration. |
|
| Prefix: |
|
(ie: Dr., Ms., CAPT, etc.) |
| * First Name: |
| |
|
| * Last Name: |
| |
|
| Suffix: |
| |
|
| Title: |
| |
|
|
| Member Number: |
| Duty Station: |
|
|
|
The following address is for my: | |
|
| * Address Type: |
| |
|
| * Address 1: |
| Address 2: |
|
| * City: |
| * State: |
|
| * Zip Code: |
| Country: |
|
| Telephone: |
| Email: |
|
| Organization: |
| Other Organization: |
|
|
|
Please choose one. |
| Profession/Category: |
| |
|
|
|
|
The rates (Please remember to refresh the page after visiting a link.) available at this time are the Early Bird rates. To qualify for the Junior Officer rate you must be a member of COA and an officer of pay grade 03 or below. To qualify for the member rate you must be a member of the Commissioned Officers Association. |
PLEASE CHOOSE YOUR RATE BELOW |
| Conference Rate: | |
|
|
You will be given the option to register for the Pre-Conference on a later page. |
|
|
If this is a Spouse or Guest registration, please provide us with the name of the sponsoring attendee below. |
| Sponsoring Attendee: |
| |
|
|
|
If you are applying for a student scholarship, please provide us with the name of your school below and your field of study above in the Profession/Category field. You will be required to show your student ID at registration. |
| College/University: |
| |
|
|
| Have you booked a room? |
|
 |