ICI Facilities Personnel Training Registration Form

ICI COLLEGE PEER AUDIT TRAINING REGISTRATION

Each person attending training must complete this registration form. There are two (2) trainees included with the original program fee paid by your institution. The cost for any additional trainees is $750 per person.

Please note that some of the registration information will be used to compile a contact sheet that will be utilized to communicate during the actual peer audits when scheduled. We are taking advantage of this opportunity to collect the information (i.e., cell phone number) rather than collect at another time. Thank you.

Registration deadline is May 26, 2008

Name:
Title:
School:
Address:
Email:
Phone:
Fax:
Cell Phone:
Special Dietary Needs/Preferences:
Accessibility/ Handicap Requirements:

Require Lodging on Campus: (Cost is $225 per person for lodging on campus and meals Tuesday-Friday) Meals only plan: (Cost $85 per person) Attending Tuesday, June 3rd, Dinner: Please pay by check and send one check per institution. Checks should be made payable to Halloran & Sage, LLP.

After submitting this form, please print it out and return with your payment to: Halloran & Sage, LLP One Goodwin Square 225 Asylum Street Hartford, CT 06103 Phone: (860) 522-6103 Fax: (860) 548-0006

If you have questions, please contact Tad Goetcheus, P.E. at 1-800-752-3922.