Conference Registration Form

If you are interested in attending one of our conferences, please fill out this form.
We will call you to confirm your registration.

All fields with an asterisk (*) are required.
* First Name:
* Last Name:
* Title:
* Organization:
* Address:
* City:
State:	Other AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY
Zip:
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* Phone:
Fax:
* E-mail:
Conference Interest:	please select a conference Results-Based Management for Govt. - May '08 Internal Branding - May '08 Strategic Internal Comm. in Gov. West – Jun. '08 Social Media Summit - Jun. '08 Social Media for Government - Jul. '08
Number of Attendees:	NOTE: If attending with colleagues, please complete this form for each attendee.
Workshop interest: Check all that apply	Workshop A Workshop B Workshop C Workshop D None
Payment Method: If paying by credit card, a customer service representative will contact you shortly for your credit card information.	please select one American Express Visa Mastercard Diners' Club Discover Company Check
Total Payment:
Priority Code from E-mail you received/How did you hear about the conference:
Comments or Questions: NOTE: Please do not hit the return key when typing your comment.
Advanced Learning Institute will not use your email address or information for any purpose other than distributing our conference and event notices. Click here to view the complete privacy policy. Cancellation Policy: You may make substitutions at any time; please notify us as soon as possible. If you cancel (in writing) more than two weeks prior to the conference, a $150 service fee will be charged and a credit memo sent reflective of that amount which can be used for a future A.L.I. conference. Registered delegates who do not attend or who cancel less than two weeks prior to the conference are liable for the entire fee. A credit will be issued which can be used for a future A.L.I. conference.