Online Workshop/Meeting Registration

Please fill out this form and submit. It will be sent to us via email.

Name: Title: Cell-Phone: Carrier: CEUs:

Name: Title: Cell-Phone: Carrier: CEUs:

Name: Title: Cell-Phone: Carrier: CEUs:

Name: Title: Cell-Phone: Carrier: CEUs:

Name: Title: Cell-Phone: Carrier: CEUs:

Place of Employment:

Mailing Address:

City: State: Zip:

E-mail address to receive confirmation letter(s):

Work Phone: Fax:

Workshop/Meeting Title: Date: Location:

 

*CEUs are Continuing Education Units. They are for special licensure. They are NOT needed for the Roads Scholar Program. Please call in any social security #'s for individuals requesting CEUs.

After Registering and Receiving Confirmation:

  1. Make check payable to: UNH Technology Transfer Center
  2. Mail to: UNH Technology Transfer Center, 33 College Rd. Durham NH 03824