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<br />'i~~~~;:::.'-''':':'~~..l:..~~-''~~"''-'''--~-''"'-~-''':''';'''~-~~~--~-------~-'-~- <br /> <br />Partners of NDC and Registration Information <br /> <br />Reg is t rat ion <br /> <br />By fax: <br />Photocopy and fax this completed form to: (859) 578-4860 (fax) <br /> <br />Online: <br />Visit NDC's Web site to register online: www.nationaldevelopmen,tcouncil.org <br /> <br />By mail: <br />Mail this form with payment (check. credit card, purchase order) to: <br />National Development Council <br />Training Division <br />927 Dudley Road <br />Edgewood, KY 41017 <br />(859) 578-4850 <br /> <br />....1" <br />. NOes EDFP and HOFP Certification <br />Programs gave me the foundation <br />- <br />to work with a broad range of community <br />development players. Through the training, <br />I acquired the skills ond abililY that allow <br />me to quickly analyze and determine <br />feasible projects." <br /> <br />An individual is not confirmed and presession materials are not sent until full payment or properly <br />certified city, state or federal voucher or purchase order has been received by Noes Training Division. <br /> <br />Prerequisites <br />Registrants must meet prerequisites. Individuals who do not qualify for a course will be <br />contacted byNDC'sTraining Division. <br /> <br />- Richard LoPresti <br />Director, Department of Economic <br />and Community Development <br />State of Connecticut <br /> <br />Registration Form <br /> <br />Complete the following (please print): <br /> <br />D Mr. D Ms. D Other <br />Name <br />Title <br /> <br />Are you planning to stay at NDC's training site? <br />DYes D No <br /> <br />Organization <br /> <br />Please indicate if you are a: <br />D Certified EDFP D Certified HDFP <br /> <br />Mailing Address <br /> <br />City <br /> <br />State <br /> <br />Telephone ( <br /> <br />Fax ( <br /> <br />E-Mail <br /> <br />Physical Address <br />(For shipping only if different from mailing address) <br /> <br />Zip <br /> <br />I would like to register for: <br />Course Name <br /> <br />Date <br /> <br />Location <br /> <br />Promotional Code <br /> <br />City <br />State <br /> <br />Zip <br /> <br />If making payment by Visa, Mastercard or American Express, <br />please complete the following: <br /> <br />D Visa D MasterCard D AM EX <br /> <br />Credit Card Number <br /> <br />r!tJ <br /> <br />NATIONAL DEVELOPMENT COUNCIL <br /> <br />Training Division <br />927 Dudley Road <br />, Edgewood,KY41017 <br /> <br />Signature <br />Exp. mo./yr. <br /> <br />12 <br />13 <br />