Copy of CMS Bootcamp - January 2018 Leesburg, VA

Registration Information

Question Title

* 1. Please complete your contact information:

First Name

Last Name

Title

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. I understand that by submitting this form that I have registered for the CMS Bootcamp - January 2018 Leesburg, VA and that training and meals will be secured for me and will be paid by SkillsUSA. If I have need to cancel my registration, I will do so as soon as possible so that the room can be released. I understand that I am responsible for my transportation (airfare or driving if applicable).

Agree

Not agree