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Name and Contact Information

First Name:

Last Name:

Organization:

Job Title:

Street Address:

City:

State: Zip code:

E-mail Address:

Day Phone :

Participant Profile

(check all that apply):

individual artist
individual representing a performing group
individual representing an organization
individual representing a school
individual representing a city or county governmental entity
individual representing a state governmental entity (includes Board of Regents)
Other (please specify:)

I will attend the following GRANT WRITING WORKSHOPS:

Tuesday, July 15,2008, Fort Madison Comfort Inn and Suites	1:00 pm - 4:00 pm
Monday, August 25, 2008, State Historical Building, Des Moines	1:00 pm - 4:00 pm
Tuesday, September 9, 2008, Clinton Cnty Historical Society Museum	1:00 pm - 4:00 pm
Tuesday, September 23, 2008, Council Bluffs Public Library	1:00 pm - 4:00 pm
Monday, December 1, 2008, State Historical Building, Des Moines	1:00 pm - 4:00 pm
Monday, February 23, 2009, State Historical Building, Des Moines	1:00 pm - 4:00 pm

I will attend the following OFFICE ON THE ROAD sessions:

Thursday, May 15, 2008, Le Mars Art Center	1:00 pm - 5:00 pm
Wednesday, July 16, 2008, Fort Madison Comfort Inn and Suites	8:30 am - 12:30 pm
Wednesday, September 24, 2008, Council Bluffs Public Library	8:30 am - 12:30 pm

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