Preregistration Form

Advance Crop Advisers Workshop
February 21 to 22, 2002

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

(Please print or type)

Name(s) _______________________________________________

Organization ____________________________________________

Address _______________________________________________

City __________________________________________________

State________ Zip_______________________

Phone ________________________________

Fee:

Registration due by Feb 15, 2002.

• $125 per person for both days
• If single day registration -- $75.

Please indicate day of attendance:

• February 21 or
• February 22

Payable to: Advanced Crop Advisers Workshop

Return form and fee to:

Advanced Crop Advisers Workshop
c/o Greg Endres
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 by February 15, 2002.

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__________________________________________