REGISTRATION FORM
PPCA CONFERENCE
UTAH STATE UNIVERSITY
NOVEMBER 7-8, 2002

Name___________________________________________________________________

Trade______________________________________Title__________________________

Institution_________________________________________________________________

Street Address_____________________________________________________________

City__________________________________State____________ZIP________________

Phone#: ______________________________Fax#: _______________________________

Email: ______________________________

Emergency Contact: ____________________Emergency Phone: ____________________

Training Session Choices (listed in the Agenda):

1)____________________________________________________________________

2)____________________________________________________________________

3)____________________________________________________________________

Will you be staying at the Comfort Inn?___________ If not, where?__________________

Will your spouse or significant other be attending with you?______________

(One form per attendee. Please return to Utah State University by 10/31/02)

Price:	$39.95 each person
Make checks payable to:	Utah State University
USU Tax ID:	87-6000-528
Mail to:	Brenda Rust, Administrative Assistant
	Utah State University 6600 Old Main Hill Logan, Utah 84322-6600 Phone: (435)-797-1950 Fax: (435)-797-3512 Email: BrendaR@fac.usu.edu