Prosimian Husbandry Workshop > Registration > Part 1 - Contact Information

Prosimian Workshop Registration
Part 1: Contact Information**

* REQUIRED FIELDS
Name:
	* First
	* Last
	Middle Initial
Professional Affiliation:
	* Organization	if none, type "self"
	Position
Contact Details:
	* Address
	Address 2
	* City
	* State/Province
	* Zip/Post. Code
	* Country
	* E-mail
	* Phone	ext.
		include area code no separator (e.g. 2165551234)
* Meal Preference
	Vegetarian No preference
Special Needs
	Please contact me (check box and someone from the conference will contact you)
Workshop Registration
	Registration includes all sessions, coffee breaks, activities, a limited-edition t-shirt and most meals. Registrants may also purchase a ticket to the optional icebreaker in the evening on April 29. Any profits made from the workshop will be donated to Madagascar Fauna Group.
	* Fees:	Workshop Registration, $150
		Ice Breaker, $20 (optional, on April 29)
	* T-shirt size: (unisex)	S M L XL XXL
	Total Amt. Due: $
Payment Information
	We accept credit card payment online via PayPal.
	If you would like to pay by check, traveler's check or money order, please download a registration form (PDF) and remit with payment (see downloaded form for additional information).
	**Please note: Your privacy is important to us. Your contact information will be used by Cleveland Metroparks Zoo for the 2009 Prosimian Husbandry Workshop proceedings only and will not be shared with any outside parties.