Register
Now

STUDENTS AT RISK:
HIV/AIDS IN THE AFRICAN AMERICAN COMMUNITY
A joint initiative between the National Association of State Boards of Education and the Centers for Disease Control and Prevention

Registration Form

May 28 - 30, 2008



Name:

E-Mail:

Function at conference:

State Board Member SEA Staff Sponsor
Local Board Member Student CDC
Chief State School Officer Speaker Other


Name as it should read on badge:


Address:      
City: State: Zip:
Telephone: Fax:  

Arrival Date:
(Input 2 digit Month followed by 2 digit day, ie: 0321 )

Departure Date:
(Input 2 digit Month followed by 2 digit day, ie: 0322 )

Special requirements: