Education, Conferences & Training

Online Registration

Education Workshop/Conference Registration Form Submit Date:

Last Name: First Name:

Rank: Department:

Address: City: State: Zip:

Phone: Fax: Email:

Are you a CLEE Graduate? Yes No

Workshop:

Need an invoice? Yes No

Send confirmation/invoice to the attention of:

PO # (if applicable):

IF APPLICABLE TO THE WORKSHOP, PLEASE ANSWER THE FOLLOWING:
Non smoking room: Yes No

If you are requesting double occupancy for another workshop attendee, please list roomate's name:

Bringing a spouse/guest? Yes No
(Includes room and meals only, workshop not included)

Spouse/Guest Name:

Comments: