Iowa Citizens for Community Improvement

Sign me up for CCI’s Statewide Convention

Real People. Real Power. Real Change.

July 18-19 (6 pm Friday – 3 pm Saturday)
Hotel Fort Des Moines (Corner of 10th & Mulberry), Des Moines

If you prefer to send your registration by mail, click here.

Your Information:
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* Street:
* City/State/Zip:
Phone:
* Email:
*Total # Attending:
I heard about CCI's convention from:

Registration:
Select one registration option below

	Early Deal (By July 6)	After July 3
Family at hotel	$100	$120
Individual at hotel	$80	$100

Family not staying at hotel	$45	$65
Individual not staying at hotel	$35	$55

Family 1 day only, not at hotel	$30	$50
Individual 1 day only, not at hotel	$25	$45
If 1 day only, which day:	Friday	Saturday

Friday's John Nichols' Keynote Only	$15 in advance

I would also like to donate $ to help offset convention costs.

Please apply my CCI Get It Done Club discount of %

Payment Information:
This is a secure site, but if you prefer to send your registration by mail, click here.

Total amount from above: $

Card Type:

Card Number:

CVV2 (3 digit code on back of card) :

Expiration Date: Month: Year: