Name:*

Title:*

Company:*

Address:*

City:*

State:*

Zip:*

Phone:*

Email:*

Comments
or Questions?

Affiliation:*

 Business/Industry

 Faculty/Education

 Labor

 Student

 Special Populations

 Other

*Required Items

Credit card payment:

 Please let us know if you would like to pay using a
credit card by checking this box. Click here to download
a Credit Card Authorization Form, fill it out and fax to
Penny Cobarrubia, LRCCD at (916) 231-5334. You can 
also pay with credit card at the registration table on the 
day of the event. 

Pay by check:

 Make check payable to LEED, include event title
in check memo field. Mail to:

Leed-Convergence 2007
P.O. Box 269003
Sacramento, CA 95826-9003

*REQUIRED: Please check event:

  Convergence IV -- Required Skills