On-Line Registration Form
** Indicates a required field
Question or Topic for Discussion:
BILLING INFORMATION (not required unless there is a registration fee for the session)
Billing Contact Name:
Billing Contact Phone#:
Billing Address same as above: Yes
Do you have a need for special services or arrangements?
Yes, please contact me regarding the need for special arrangements
Please Add me to your Mailing List
Please Add me to your Public Works Listserv
Please Add me to your LTA Listserv
REGISTRATION FEE PAYMENT:
Sending check in the mail
Purchase Order/Voucher (enter #)::
Payment is due prior to the date of the workshop.
If paying by check, please make payable to UConn and
Technology Transfer Center
Attn: Carolyn Ward
270 Middle Turnpike, Unit 5202
Storrs, CT 06269-5202
BEFORE submitting...PRINT or "SAVE AS..." a copy of this registration for your records.
Be sure you have entered ALL information requested.
A confirmation of your registration will be sent to you soon.
Cancellation Policy: If your plans change and you cannot attend, a colleague may attend in your place - just send us a fax or letter. Cancellations and requests for
refunds must be made in writing. 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.
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