Please complete the following information to register for this event.

First Name:		Middle Initial:
Last Name:
Agency:
Address 1:
Address 2:
City:		State:
ZipCode:
Phone # (you must include area code):	() -Ext.
Email Address:

Select the site you would like to attend from the drop down box below.

Site: 79        Atlantic 452      Bellevue 453      Bettendorf 266      Burlington 481      Cedar Falls 198      Cedar Rapids 695      Cedar Rapids 176      Clear Lake 205      Council Bluffs 173      Creston 311      Dubuque 154      Fort Dodge 200      Guttenberg 507      Independence 827      Iowa City 187      Johnston 203      Marshalltown 326      Melcher 237      Ottumwa 352      Red Oak 24        Sioux Center 197      Sioux City 657      Sloan 202      Spencer 533      West Union

Go to Iowa Distance Learning Database for information about which site is closest to you. Select your site by typing the ICN classroom node number (the three digit number that in front of the site name) in the appropriate box. You will then be able to get the address of this particular ICN site. If you have questions about whether the site is accessible, use the contact information on the site listing. The rest of the information is not relevant to this training. For all other questions, please contact Brenda Nosbish; Brenda-nosbish@uiowa.edu; 319-353-6008.

If you need special accommodations please list them in the box below.

Individuals with disabilities are encouraged to attend all University of Iowa-sponsored events. If you are a person with a disability who requires an accommodation in order to participate in this program, please contact Brenda Nosbish in advance at (319) 353-6008.