* Required Fields

* Select the form of payment you will be using:

PayPal      Check/money order      Purchase order      Direct Payment

***Remember to indicate requests for accommodations.***

* Name:
* Job Title:
* Organization:
* Address:
* City:
* State:
* Zip Code:
* Telephone (WORK):
Telephone (CELL):
Fax:
* E-mail:
* Accommodation Requests (dietary restrictions, accessible format materials, interpreter services, or other needs)
Yes       No
If you checked "Yes", please be specific:
* I would like to be contacted regarding other regional trainings and events
Yes       No
* Include my contact information (above) in the participant list distributed to conference registrants
Yes       No
Note: Training materials will be provided on CD for each participant. Your registration will be confirmed upon receipt of registration form and payment. Registrations with payment must be received on or before February 26, 2009. Cancellation notices must be received on or before March 5, 2009 to receive a refund. For more information, please contact the DBTAC: Mid-Atlantic ADA Center, Toll-free in DC, DE, MD, PA, VA, WV 1-800-949-4232 (V/TTY), 301-217-0754 (FAX), or e-mail adainfo@transcen.org. Thank you for not using scented products. The DBTAC: Mid-Atlantic ADA Center is one of ten regional centers funded by the National Institute on Disability Rehabilitation and Research (NIDRR), the US Department of Education (grant # H133A060085), to provide technical assistance, training, and materials on the Americans with Disabilities Act.

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©2008-2009 DBTAC: Mid-Atlantic ADA Center