Registration for the 2016 Minnesota TZD Regional Workshops Question Title * 1. Please select the TZD regional workshop(s) you would like to attend. Check all that apply. 4/13 Metro: Oakdale, The Prom Center (register by March 31) 4/22 Southwest: Morton, Jackpot Junction (register by April 8) 4/26 South Central: Mankato, Country Inn & Suites (register by April 12) 5/5 Southeast: Rochester, International Event Center (register by April 21) 5/9 West Central: Ottertail, Thumper Pond (register by April 26) 5/16 East Central: St. Cloud, MnDOT Training Center (register by May 3) 5/25 Northwest: Bemidji, Sanford Center (register by May 11) 6/16 Northeast: Duluth, Spirit Mountain (register by June 3) Question Title * 2. First Name: Question Title * 3. Last Name: Question Title * 4. Organization: Question Title * 5. Title: Question Title * 6. E-mail address: Question Title * 7. Confirm e-mail address: Question Title * 8. Phone: Question Title * 9. Street Address: Question Title * 10. City: Question Title * 11. Zip Code: Question Title * 12. Fax: Question Title * 13. 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) Question Title * 14. Have you attended a TZD event in the past? Yes No Question Title * 15. If you have special dietary needs please list here: Next