E-Gov Services Pikeville City

WARNING! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.

East Kentucky Leadership Conference Registration

Click here to Login | Click here to Register

To Register for the Conference: You must create a user id for the website first. Purpose. REGISTRATION FORM: East Kentucky Leadership Conference. To pay online at: http://pikevilleky.gov

* Information is required.

Contact Information

* First Name:
* Last Name:
* Email:
* Daytime Phone:	() –
* Address:
* City:
* State:
* ZIP:

* I HAVE READ AND FULLY UNDERSTAND THE RULES FOR THE EVENT.

YES

* Are you a student?

* Please indicate which meals you will attend?

Thursday Lunch
Thursday Dinner

Friday Continental Breakfast
Friday Lunch

Registration includes all meals. Early Registration Fee is $50.00 (must be postmarked by April 17, 2015) Late Registration Fee is $60.00 (postmarked after April 17, 2015) Student Registration Fee is $25.00 per student

In order to process your payment, you will need to enter payment information on a separate form, which we will open in a separate window.

Here are the steps:
1. Click on the link below
2. Type in the following information:
Group Name: YOUR INDIVIDUAL NAME
Payment Amount: Enter the amount you must pay for the conference based on above.
3. VERY IMPORTANT: Come back to this window and submit your registration details.

Please click here now to open the form. NOTE, you still need to submit your registration information in this window, and payment information in the other window. You need to complete both processes to have a completed registration.

Leave this field blank:

Attach a Picture or File (max size: 30MB):

Add Another FIle

CAPTCHA

Check here to have email confirmation of this submission.

* Information is required.

Notes:

Minta Trimble, Pikeville Main Street; minta.trimble@pikevilleky.gov for more information. Remember to click back to make payment for conference.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.