Registration FormCommunity Analysis for Economic
Development Please submit by September 18, 2007 If registration has not been confirmed within 48 hours, please call Rita DeLoney at (501) 569-8519. Thank you. |
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Mr. ____Mrs. ____Other (specify) _____________________________________________ Name: ___________________________________________________________ Title: ____________________________First Name Preferred on Badge: ________________ Economic Development Affiliation (organization name): ________________________________________________________________________ E-mail address: ____________________________________________________________ Street or P.O. Address: _______________________________________________________ City, State, Zip: ____________________________________________________________ Work Phone: __________________________ Fax: _____________________________ Alternate Phone: __________________________ Education (please check highest level attained) Please check the one category that best describes the economic development
group with which you are most closely affiliated. At what geographic scale do you most frequently participate in economic
development? Fees:$225 Total $ ______ (Enclose check or purchase order copy, payable
to UALR Institute for Economic Advancement) or __________ invoice me. Signature __________________________________________Date _________________ Please indicate any special dietary or other needs you may have during the course. Fax completed form to 501-569-8538 or send to:
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