78th Winter Meeting
The U.S. Conference of Mayors
78th Winter Meeting
Washington, DC
January 20-22, 2010

WORKFORCE DEVELOPMENT COUNCIL MEMBER REGISTRATION FORM

First Name *:
Last Name *:
Title:
Organization *:
Street Address *:
Street Address 2:
City *:
State *:
Country:
ZIP *:
Phone *:
Fax:
E-Mail *:
Preferred Name on Badge (FIRST NAME ONLY) *:
Attendee(s) has
special needs *:
 Yes No
(If you have special needs USCM will contact.)

Payment Information
Registration Fees (select one) *:

Advance Registration Fee
(Payable by December 30, 2009):		$600

Refunds will be made for cancellations received in writing by December 30, 2009 (less a $100.00 service fee). NO REFUNDS will be made for cancellations received After December 30, 2009.