IMPORTANT NOTICE:
Due to technical difficulties, registrations submitted for the December Alcohol Course may not have been received by the Center. If you registered online for the course between 9/15 and 10/15 and have not received confirmation, please resubmit your registration online or contact Suz Frederickson. We apologize for any inconvenience. Thank you.

COURSE APPLICATION FOR:

THE ROBERT F. BORKENSTEIN COURSE ON ALCOHOL AND HIGHWAY SAFETY: TESTING, RESEARCH AND LITIGATION
December 7 - 12th, 2008

Please complete the following application form; we will review it for acceptance and then will notify you soon regarding your application status and payment details.

Title (please check one)		Mr. Mrs. Ms. Miss
Name
		(exactly as you want it to appear on your certificate)
Job Title
Organization
Address of Organization
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Date of Arrival in Bloomington
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Lodging (please check one):		Single ($89 weekday, $109 weekend) Double ($109 weekday, $139 weekend) Queen Double ($119 weekday, $149 weekend) King ($119 weekday, $149 weekend)
Are you sharing a room with someone?		Yes No