Registration Form please print form, fill out and mail in with a check made payable to GMDVP before November 21st, 2006 to: Curt Rogers GMDVP 955 Massachusetts Ave, PMB 131 Cambridge, MA 02139
Contact Curt at crogers@gmdvp.org with questions about payment. |
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Conference Rates: The cost of this day-long conference is $50 per person for organizations sending 1-2 individuals, $40 per person for organizations sending 3-5 individuals, $35 per person for organizations sending 6 or more individuals. Scholarships are available. Space is limited. Contact crogers@gmdvp.org regarding scholarships |
Number of people attending the conference ______________
Organization:_________________________________________ Phone Number:______________________________________
Amount Enclosed:_____________________________________ Address:____________________________________________
Registrant 1 Name:_____________________________________________ Title:_______________________________________________ Email Address:_______________________________________
Registrant 2 Name:_____________________________________________ Title:_______________________________________________ Email Address:_______________________________________
Name:_____________________________________________ Title:_______________________________________________ Email Address:_______________________________________
Registrant 4 Name:_____________________________________________ Title:_______________________________________________ Email Address:_______________________________________ |