On-Line Event Registration Form

Name of Event

Date of Event

REGISTRATION INFORMATION

Always use the TAB key to move through this form

* NAME
* TYPE OF ATTENDEE
* ORGANIZATION
* PHONE
FAX
* E-MAIL
GUESTS Name & Email ( req'd )	(email) (email) (email)
SPECIAL ACCOMODATIONS OR MEAL REQUIREMENTS
SUGGESTIONS FOR FUTURE TOPICS
Late Fee Registration	Type "yes" if late otherwise leave blank
* PRICE

* The fields in red must be filled out in order to be submitted.

If you have any questions about Akron SHRM, need to cancel, or trouble with the online event Registration form, please contact Kerry Ilkanic at 330-926-1880 x-132 or kerryi@workplacestaff.com.

"If you missed the midnight September 8, 2010 registration deadline!! Please type YES in the Late Fee box above and contact Kerry Ilkanic at kerryi@workplacestaff.com or call 330-926-1880 x-132 for seating availability"