Name:
Title:
Organization:
Address:
City:
State:
Zip:
Telephone Number:
Fax:
E-mail:
Do you agree to share your contact information on the training participant list distributed only to Workforce Discovery 2008 training participants?
Yes       No
Please note specific accommodations that you will require to participate in the training (e.g., accessible formats, interpreter services, dietary restrictions):
Please note which form of payment you will be using:
PayPal       Check/Money Order       Purchase Order
Additional notes or comments: For more information, call toll free: 1-800-949-4232 V/TTY or 301-217-0124 V/TTY, fax 301-217-0754, e-mail adainfo@transcen.org, or visit us at www.adainfo.org/diversity/. Deadline to cancel with full refund is Monday, May 12, 2008.