REGISTER HERE

	1. By Phone ... Call (800) 621-1136 and register using a purchase order number or credit card. The tuition fee is $195 per person.     2. Online... Please submit this Registration Form and we will confirm your reservation by e-mail.   Attendee Profile Thank you for completing this form. It will help us customize the workshop to meet your specific needs and interests. 1. Is your fire department....      Paid  Volunteer  Combination  2. Has your department received a grant?      No  Yes  Multiple  Unknown  3. Do you work with your department full-time?      Yes  No  4. Please indicate your grant writing experience.       Beginner  Intermediate  Very Experienced 5. How would you describe your computer skills?      Limited  Moderate  Advanced  A Wizard 6. Which part of the grant team are you?   (check all that apply)      I am (or will be) the grant proposal writer      I plan to do the research      IÕm the team leader and will delegate responsibilities      My grant writing responsibilities are not yet defined 7. What is your fire departments greatest need?      (Please check only one)      Facility construction or remodel      Vehicles       Personnel Training       Public Education       Firefighting Equipment       Personal Protective Equipment       Other Thank you
REGISTRATION FORM Please submit a separate form for each registrant     January 29th Alpine, CA

Workshop City: First Name: Last Name: Organization: Address: City: State/Province: ZIP/Postal Code: Phone: Fax: Email: PAYMENT METHOD     Your Purchase Order#: OR Credit Card #: Name on Card: Expiration Date (mm/yy):