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MD State Steering Committee and DC/MD Chapter AER Fall Workshop Registration FormLocation: Workforce & Technology Center 2301 Argonne Drive, Baltimore, Md. 21218Tuesday November 7, 2017 8:30 A.M. 3:00 P.M.(Registration & Continental Breakfast 8:30 to 9:30 A.M.)InformationName ______________________________________________________________________________Address________________________________________________________________________City ______________________State____________Zip Code ___________________________Telephone (H) _______________________ (W) ______________________________________(Cell) ___________________________ Email: ________________________________________Agency/OrganizationSchool/Organization______________________________________________________________Position________________________________________________________________________Make Check out to: DC/MD AER $20 Breakfast and Lunch Included! Amount Enclosed $__________ Accommodations will be provided upon request. Please specify:____ Large Print ____Braille ____Electronic ____Dietary:____________________ Deadline for Registration: October 23, 2017Mail completed form to: Kerry Michael The Maryland School for the Blind, Outreach Department, 3501 Taylor Avenue, Baltimore, MD 21236 Phone: 410-444-5000 ext. 1249 FAX: 410-319-5708 Email: kerrym@mdschblind.org |