Advanced Crop Advisers Workshop
Preregistration Form


Workshop enrollment will be filled on a first-come/first-serve basis

Please print or type

Name(s) ______________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Organization ___________________________________________________________________________

_____________________________________________________________________________________

Address ______________________________________________________________________________

City ________________________________________________________  State ____________________

Zip ________________________________  Phone ___________________________________________

e-mail _______________________________________________________________________________

 

Fee:  $125 per person required by February 12, 2001

Please make check payable to:
    Advanced Crop Advisers Workshop

Return form and fee to:
    Advanced Crop Advisers Workshop
    c/o Greg Endres
    Carrington Research Extension Center
    Box 219
    Carrington, ND  58421
    (701) 652-2951    fax (701) 652-2055

Requests for accommodations
related to disability
should be made to
Greg Endres at 701-652-2951 or
gendres@ndsuext.nodak.edu
by February 1, 2001  

Please check any accommodations you may need during the conference:

sign language interpreter
FM amplification system (specify type ________________________________)
audio-tape materials
sighted guides for assistance to/from specific sessions
large print
Braille
other _______________________________________________

NDSU Extension Service, North Dakota State University of Agriculture and Applied Science, and U.S. Department of Agriculture cooperating.  Sharon D. Anderson, Director, Fargo, North Dakota.  Distributed in furtherance of the Acts of Congress of May 8 and June 30, 1914.  We offer our programs and facilities to all persons regardless of race, color, national origin, religion, sex, disability, age, Vietnam era veterans status, or sexual orientation; and are an equal opportunity employer.  This publication will be made available in alternative formats for people with disabilities upon request, 701/231-7881.


NDSU Vice President,
Dean and Director for Agricultural Affairs
NDSU Extension Service ND Agricultural
Experiment Station
NDSU College of Agriculture NDSU College of Human Development and Education