Project ACCESS Training Registration

College of Education

Ziggurat Workshop
Sponsored by Project ACCESS

Training Information

A separate registration form is required for each person wishing to attend.

Name: Ziggurat Workshop

Date of training: December 18th and 19th

Fee: $135 (parents may attend for the discounted rate of $100)

Location: Columbia, Missouri, Hilton Garden Inn

Identification Information

First Name:
Last Name:
Title or Position:
School or Organization:

Billing Address

Billing Address:
City:
State:
Zip:

Home Address

Home Address:
City:
State:
Zip:

Contact Information

E-Mail: (Required)
Work Phone:
Work Fax:
Home Phone:

Billing Information

Amount Sent by Mail:
Check Number:
Purchase Order Number:

Please check this checkbox to indicate that you have read and understood the cancellation policy.

Please make checks out to: Project ACCESS and mail them to

Joan Armstrong
Project ACCESS/MSU
901 S National Avenue
Springfield, MO 65897

If you have not received a confirmation e-mail by one week prior to the training, CALL TOLL FREE:
1-866-481-3841 or email tina333@missouristate.edu for verification of your registration.

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Ziggurat Workshop Sponsored by Project ACCESS

Ziggurat Workshop
Sponsored by Project ACCESS