Indiana Economic Development Course Registration Form

BBC Indiana Economic Development Course Registration Form

The 2010 Indiana Economic Development Course will be held January 11th - 15th, 2010 at the Horizon Convention Center in Muncie, Indiana. The course fee is $579 for instruction, materials, and the provided meals for the week. Applications are now being accepted and space is limited, so please submit your request early. If you have any questions, please direct them to Rose Wright at (765) 285-1628 or rwright@bsu.edu.

Please complete the following form and click submit when you have finished.

Items with an * indicate a required field.

Please provide the following contact information.
First Name *
Last Name *
Company *
Job Title *
Address Line 1 *
Address Line 2
City *
State *
Zip *
County *
Phone *
Fax
E-mail address *
Years of Education *
Are you receiving a scholarship to attend this course? *	Yes No
If yes, from whom?
Please indicate special accommodations or dietary needs (including food allergies/vegetarianism/etc.) of which we should be made aware. The standard provided meals offer several vegetarian options, but special vegetarian meals are available upon request.


Please indicate how you would like to pay
Payment Method *

Completion of this registration form does not guarantee your participation in the course. You will be notified within ten business days of your status.