Registration for the 2017 Minnesota TZD Regional Workshops

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* 1. Please select the TZD regional workshop(s) you would like to attend. Check all that apply.

4/19 Metro: Roseville, The Radisson Hotel Mpls/N St. Paul (register by April 5)

4/21 Southwest: Redwood Falls, Community Center (register by April 7)

5/3 Southeast: Rochester, International Event Center (register by April 19)

5/4 South Central: New Ulm, Conference Center (register by April 19)

5/11 West Central: Ottertail, Thumper Pond (register by April 26)

5/23 Northwest: Bemidji, Sanford Center (register by May 9)

5/24 East Central: Brainerd, The Woods (register by May 9)

5/31 Northeast: Duluth, Northland Country Club (register by May 16)

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* 2. First Name:

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* 3. Last Name:

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* 4. Organization:

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* 5. Title:

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* 6. E-mail address:

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* 7. Confirm e-mail address:

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* 8. Phone:

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* 9. Fax:

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* 10. Street Address:

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* 11. City:

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* 12. County:

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* 13. Zip Code:

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* 14. What is your stakeholder designation? Please select all that apply.

Advocacy Group

Community Member

Child Passenger Safety

Education

Emergency Medical & Trauma Services

Enforcement

Engineering

Judicial

Legislative/Elected Official

Private Industry

Public Health

Research/Academia

Other (please specify)

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* 15. Have you attended a TZD event in the past?

Yes

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* 1. Please select the TZD regional workshop(s) you would like to attend. Check all that apply.

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* 2. First Name:

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* 3. Last Name:

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* 4. Organization:

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* 5. Title:

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* 6. E-mail address:

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* 7. Confirm e-mail address:

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* 8. Phone:

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* 9. Fax:

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* 10. Street Address:

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* 11. City:

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* 12. County:

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* 13. Zip Code:

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* 14. What is your stakeholder designation? Please select all that apply.

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* 15. Have you attended a TZD event in the past?

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* 16. If you have special dietary needs please list here: