Wufoo

Chapter Name *
I am?
Are you the official voting representative designated by your chapter? *
Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Number ### - ### - ####
Cell Phone Number ### - ### - ####
Email *
Preferred Roommate
Arrival Date MM / DD / YYYY
Arrival flight information (into St. Louis)
Departure flight information (from St. Louis)
We will be driving. Please send detailed directions.
Yes No
In case of emergency, notify: First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number ### - ### - ####
STEP 1 of 2 - You will be redirected to a page for your credit card information.

If you are registering as representative #3 or #4 C.O.P.S requries a $400 registration fee. Your credit card will be charged only for that amount. If you are not the 3rd or 4th rep, your card will not be charged. You will receive a copy of your form shortly after submission. If you don’t, please contact the National Office at cops@nationalcops.org.
Please check the box below. *
Do Not Fill This Out