County Contact InformationFirst Name (to appear on badge)*Last Name:*Title:*County/Organization:*Address* Street Address City State / Province / Region ZIP / Postal Code Telephone*E-mail* ADA Needs / Dietary RestrictionsAccessibility Needs:Dietary RestrictionsNoneVeganVegetarianGluten freeOther - explainPre-Summit EventsPlease Indicate Interest in: Golf at Talking Stick Resort CSA Summit Events Please mark Yes if attending the full Summit -- you DO NOT need to check individual session boxes below: If No, please check only the sessions you will be attending:I will be attending the FULL Summit:*YesNoIf NO, please list the events you will be attending.Tuesday, October 24, 2017 Opening Reception/Dinner Wednesday, October 25, 2017 Morning Session Hosted Luncheon Afternoon Session Maricopa County Hosted Dinner Thursday, October 26, 2017 Morning Session Board of Directors Meeting Spouse/Guest Events (for social events ONLY) PLEASE NOTE: A SPOUSE/GUEST CANNOT BE A COUNTY EMPLOYEE! The full participant fee (not the guest fee) MUST be paid if a spouse/guest attends the Summit working sessions.Spouse/Guest First Name (to appear on badge)Spouse/Guest Last Name >Spouse/Guest Events (for social events ONLY):My spouse/guest(s) is interested in the following Pre-summit event: Golf at Talking Stick Resort CSA Events:Tuesday, October 24, 2017 Opening Reception/Dinner Wednesday, October 25, 2017 Hosted Luncheon Maricopa County Hosted Dinner Summit Fees County Participant Fee: $230.00 per person Spouse/Guest Fee (non-county employee): $100.00 per person Fees/Rates are valid for entire Summit and/or individual events Make Checks Payable to: County Supervisors Association of Arizona 1905 W. Washington St., Suite 100 Phoenix, Arizona 85009 (602) 252-5521 Cancellation Policy Registrants who are unable to attend may appoint a county substitute. Please notify CSA of a registrant substitution no later than Friday, September 29, 2017 Send written notification to email@example.com. Cancellations prior to September 15, 2017, will receive a full refund. Cancellations AFTER September 15, 2017, will incur a $50.00 processing fee. * No refunds after September 29, 2017 (Registration Deadline). * Cancellations may be mailed, faxed (602-253-3227) or e-mailed to firstname.lastname@example.org. * Cancellations MUST be in writing. * * Cancellations will not be accepted by telephone. * * I have read and agree to the terms of the cancellation policy. You must confirm! Comments...Thank youSubmit Form Select to send a copy of this form to the registrant. E-mail Invoice to: Hotel Registration: Please contact the hotel directly to make reservation. Please click on the Hotels tab for more information on a room block.