IL NET Onsite Registration Form

This is not an online form, you must copy it into your email or print out and mail in!

YES!  Please register me for the seminar: Please indicate name of seminar and dates here______________ 

Payment information: Please enclose a check, or money order, or Credit Card information with your completed registration form and return it to: 

NCIL
1710 Rhode Island Avenue, NW, Fifth Floor
Washington, DC 20036  
Fee:  (Please be sure of proper amount)

Credit Card # __________________________________
(ONLY  VISA and MasterCard  are accepted)
Exp. _____________Amount  $__________________
Print name:___________________________________
Authorizing Signature: _________________________
A $15.00 administrative fee will be charged for refunds.

For the safety and comfort of those with chemical and environmental sensitivities, please refrain from using any perfumed grooming products such as scented soaps, deodorants, perfumes, and colognes. In addition, it is essential that we maintain a smoke-free environment. 

Help IL NET Provide the Right Format for You

Training Materials:    
____ Large Print  ____ Braille   ____  Audio Tape   ____ Diskette

Additional Services:
____ Assistive Listening Device

Interpreter:   
____ ASL  ____ Contact Sign  ____Oral

Other _____________________________________

It is the responsibility of each participant to arrange transportation and hotel accommodations. It is highly recommended that you make travel arrangements immediately.

___I can't attend but would like to purchase the training materials for ? (please check with NCIL to get proper amount) including the seminar audio tapes and training materials (specify format).

Name:   
Title:   
Organization
Mailing Address: 
City: 
State:
Zip: 
Phone: 
TTY
Fax:  
E-mail:
 

If you have any questions or concerns please feel free to contact me.

Tim Fuchs
National Council on Independent Living
Not Just Responding To Change, But Leading It.
202-223-6220 (V)
202-223-6277 (FAX)
ilnet@ncil.org
www.ncil.org

The mission of the IL NET is to provide training and technical assistance on a variety of issues central to independent living today--understanding the Rehab Act, what the statewide independent living council is and how it can operate most effectively, management issues for centers for independent living, systems advocacy, computer networking, and others. Training activities are conducted conference-style, via long-distance communication, webcasts, through widely disseminated print and audio materials, and through the promotion of a strong national network of centers and individuals in the independent living field.

Substantial support for development of this publication was provided by the Rehabilitation Services Administration, U.S. Department of Education. The content is the responsibility of ILRU and no official endorsement of the Department of Education should be inferred.

This site is hosted as a courtesy of Baylor College of Medicine
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Contact Us: IL NET or ILRU
713.520.0232 (V/TTY)
713.520.5785 (Fax)

Last Modified: 01-09-06