WORKSHOP REGISTRATION FORM
First Name
Last Name
Name as it should appear on badge
Job Title
Agency
Deparment/Bureau/Office
Address 1
Address 2 (if applicable)
Address 3 (if applicable)
City
State
ZIP/Postal Code
E-mail
Please confirm e-mail address
If you do not receive a confirmation within one week, please contact Stephanie Connor at
sconnor@loreleievents.com
or
212.838.2660 ext. 14
.
