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Mail To:                                                                                                     Email to:
Registration Services                                                                            registration_services@ua.edu
The University of Alabama
Box 870388
Tuscaloosa, AL 35487

Children’s Trust Fund Grantee Training 

October 10-11, 2023
Renaissance Montgomery Hotel & Spa at the Convention Center

Participant  (CS-2310-CTF001-01)
[ ] $150   Registration Fee

Please submit this entire page for your registration. For multiple registrations, please duplicate this form.

[ ]Mr. [ ]Ms. [ ]Dr. First:________________________Middle Initial:________Last:________________________

Company/Organization Name:_____________________________________________

Mailing Address:____________________________City:____________________________State:________Zip:______________

Email Address:____________________________Phone:____________________________

Job Title:____________________________

[ ] Enclosed is a check for $____________________________ made payable to THE UNIVERSITY OF ALABAMA

[ ] Purchase order is attached.

[ ] Charge $____________________________to credit card: [ ] MasterCard [ ] VISA [ ] American Express [ ] Discover

Card #____________________________Exp. Date (M/Y)____________________________

Security / Verification / CVV Code____________(Three or four digit code on back or front of credit card.)

Authorizing Signature:_________________________________________

 

A certificate verifying attendance and contact hours will be issued to all participants.

Note: The University of Alabama is committed to complying with the Americans with Disabilities Act. Requests for accommodation of physical and/or dietary needs should be made at least 30 calendar days in advance of the program date. Please email your request to professionaldevelopment@ua.edu. A portion of the invoice amount for this program will go to the Capstone Lifelong Learning Foundation to support activities of The University of Alabama and the Office of Teaching Innovation and Digital Education. Need our STAARS Vendor Number? Please use VC000118827 for UA Office of Teaching Innovation and Digital Education.

Questions? Contact Amanda Bergeron at 205-348-9966 or email professionaldevelopment@ua.edu.