Full Name:
Company:
City:

Exactly as you want this information to read on your badge! There will be a $50 charge to change the badge from what you enter here! The remaining information must be completed in order for your registration to be processed. Please use the address where you are located (your mailing address), not your parent company or central office. ALL INFORMATION requested below must be completed, or this application will be considered incomplete and will be returned to you. Thanks!

Street Address
State	ALAKASAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Zip
Phone
Fax
E-Mail (very important!)

Yes, it's okay for the Conclave to tell others I'll be in attendance this summer and I understand the Conclave will not sell this information!

The Conclave Learning Conference 2012

I want a single, full professional $299 tuition for the industry's premier Learning Conference in 2011. For multiple registrations, please use the faxable registration form. The $299 tuition may be used by all industry professionals, students & educators, and free-agents.

TO PAY FOR TUITION. Please check your preferred payment option:

I will pay online using PayPal (Please click on the PayPal link found on the "Thank You" page you will see after you submit this form to verify and pay for your tuition.)

I will be sending a check (which must arrive at the Conclave office within one week after registration), payable to "The Conclave". Address: The Conclave, 4517 Minnetonka Blvd, #104, Minneapolis, MN 55416.

DONATIONS. If you'd like to donate to the Conclave, go to www.theconclave.com and click on the "Donate" button (located at the bottom of the blue links on the left of the home page). Thank you.

Where did you hear about this Learning Conference?
My employer A co-worker A friend/relative My school A trade publication Internet website (list: ) Other (list: ) I've attended in the past

Employed by:
Radio Records Vendor/Supplier Trade Publication Student/Educator Other:

My primary position:
GM OM PD Sales Mgr/Acct. Exec Promo. Director Prod. Director Air Talent Other:

Your format:
AAA AC/Hot AC/Movin'-type Alternative Christian/Religious Classic Rock Country Dance Hispanic (all variations) News/Talk Non-Comm/Public Radio Oldies/80's/Jack-type Rock (Active, Mainstream) Sports/Talk Top 40 Urban(Urban, Urban AC, Hip Hop) Other:

THANK YOU – AND SEE YOU THIS SUMMER FOR THE 37TH LEARNING CONFERENCE!