Workshop Online Registration Form

On-line Workshop Registration Form
Please select workshop information:

Workshop Type:

Workshop Date/Location:

Use your browser's "back" arrow to return to the workshop schedule or flyer.
NOTE: This page now works properly in Internet Explorer, NetScape & Mozilla - fixed 8/5/05

Applicant Name:       Today's Date:

Title:       Name Tag Name:

Organization:

Mailing Address:



Phone#:      FAX#:      Email address:
Favorite NE "Problem" Intersection:

Yes, please contact me regarding the need for special arrangements
Do you need a Certificate of Attendance (for CEU's or PDH's)?

Please choose your sector:
Registration Fee: Purchase Order# (if any):

Payment is due prior to the date of the workshop. Please make checks payable to NorthEast Area Roundabouts & mail to:	NorthEast Area Roundabouts P.O.Box 201 Stafford, Ct 06075
Submit form: Be sure you have entered ALL information requested. PRINT a copy for your records of the registration acknowledgement (confirmation screen). An email confirmation will be sent to you in 24-48hr with Invoice attached.	Cancellation Policy: If your plans change and you cannot attend, a colleague may attend in your place. Full registration fee is refundable if notice is received 10 days prior to the start of the workshop. No refund of the registration fee will be made if you are unable to attend and do not cancel in advance. No check is deposited by NEAR until our minimum enrollment is achieved.

Return to NEAR Workshop Listing

If http://www.formmail.com is down, print & mail form, & email me to reserve your place.