Online Registration Form

Deaf and Hard of Hearing in the Workplace

Wednesday, June 11, 2008
8:00 AM - 11:00 AM
Massachusetts General Hospital
165 Cambridge Street, Room 210/215, Massachusetts, 02114

First Name*		Last Name*
Title*		Company*
Address*		Suite/Apt
City*		State*
Zip Code*		Phone*
Fax		Email*

Additional Attendees Please list in the fields below any other employees from your company that will be attending the seminar. Additional employees each receive a 15% discount. Discount taken at checkout.
	First Name	Last Name	Title	Email	Company
Employee 1
Employee 2
Employee 3
Employee 4
Employee 5
Employee 6

Payment Method
I will pay through PayPal (Credit cards are accepted)
I will send a check prior to attending the seminar
I have a discount code:

Do you need an accommodation?
No
Yes

If yes, please describe:

Comments: