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2008 National Equal Opportunity Professional Development Forum

2008 Registration Form

Submit one form for each forum participant. Photocopies are acceptable.

Please provide all of the following information, as it will appear on your name badge and forum certificate.

__________________________________________________

FIRST NAME

__________________________________________________

LAST NAME

__________________________________________________

BADGE FIRST NAME (if different from first name)

__________________________________________________

ORGANIZATION/COMPANY

___________________________________________________

ADDRESS

___________________________________________________

CITY/ STATE/ ZIP

___________________________________________________

PHONE FAX

___________________________________________________

E-MAIL

SPECIAL SERVICES

If you have any special needs (mobility, hearing, vision, or dietary), please specify.

REGISTRANT AFFILIATION

Check only one please.

  • State Workforce Administrator
  • Navigator
  • Job Corps Center Staff
  • State EO Officer
  • Civil Rights Center Staff
  • ETA Regional Staff
  • Job Corps Contractor Staff
  • LWIA Staff/EO Office
  • Older Worker Program Staff
  • Monitor Advocate
  • ETA National Office Staff
  • Work Incentive Grant Staff
  • Indian and Native American Program Staff
  • Other ____________________________

HOTEL INFORMATION

All forum activities will be held at the Crystal Gateway Marriott, 1700 Jefferson Davis Highway, Arlington, VA 22202. If you would like to stay at the conference hotel, you may contact the hotel directly at (703) 920-3230 (Local) or 1-800-228-9290 (Marriott Reservations). Please state when making your reservations that you would like to make a reservation with the USDOL EO Forum, August 24-29, 2008 to receive the special discounted forum rate of $154.00 for single/double occupancy. This special discounted forum room rate does not include sales tax or occupancy tax. The special discounted forum room rate is guaranteed through August 4, 2008. After that date, rooms may be available, but a higher rate may apply.

CANCELLATION POLICY

Substitutions will be accepted at any time. THERE WILL BE NO REFUNDS UNDER ANY CIRCUMSTANCES. All substitutions MUST be made in writing via fax to the Civil Rights Center, Attn: Vicky Best-Morris, Fax (202) 693-6505.

REGISTRATION FEE

$400.00 Registration

Are you attending the networking reception? Yes No

PAYMENT INFORMATION

Enclosed is the registration fee in the amount of $ __________

Payment is being made by:

  • Purchase order (enclosed). Please note that a purchase order only reserves a space at the forum until full payment is received. Purchase order number: _________________
  • Credit Card (Visa/Mastercard/Discover) Credit Card No.___________________ Exp. Date _____
  • Check (enclosed; make payable to TATC) Check number: ____________________
  • Money order (enclosed; make payable to TATC) Money order number: ____________________

Please mail your registration form, along with payment to: TATC 7315 Wisconsin Avenue, Suite 1200W Bethesda, MD 20814-3202 Re: DOL National EO Professional Development Forum-August 24-29, 2008 Fax: (301) 652-2021 Federal Tax ID # 52-0893858 ATTN: Lloyd Celistan/Terry Williams

We request payment for all registrants be made in full prior to the conference.

The cut-off date for reserving a space with a purchase order is July 18, 2008. For those who have submitted a purchase order closer to the July 18th date, we recommend that you bring the check with you rather than mailing it, to ensure confirmation of payment to attend the forum. In the event that we have not received payment or you do not have a processed check for payment from your agency prior to your arrival, you will be required to reconcile any balance due by check or credit card upon arrival on-site.

If there are participants interested in registering for the forum after the July 18th purchase order cut-off date, you may pay your registration with a credit card only. Please understand that there will be an additional service charge of $17.00 per transaction made with a credit card bringing the conference registration fee to $417.00.

FORUM INFORMATION: For assistance regarding forum information, including registration, contact: USDOL/Civil Rights Center Vicky Best-Morris at best-morris.vicky@dol.gov or Samuel L. Rhames, Jr at rhames.samuel@dol.gov (202)-693-6500 (voice) or (202)-693-6515 (TTY) National Association of State Workforce Agencies, EO Committee Alice McVey at amcvey@workforcewv.org (304)-558-1600 (voice only)