<table style="width:100%;">
<colgroup>
<col style="width: 2%" />
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<col style="width: 1%" />
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<col style="width: 4%" />
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<col style="width: 2%" />
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<col style="width: 4%" />
<col style="width: 4%" />
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<col style="width: 6%" />
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<col style="width: 5%" />
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<col style="width: 3%" />
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="28"></td>
<td colspan="6"></td>
<td colspan="4"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="28"><p>CONFERENCE ATTENDEES INFORMATION</p>
<p>(PLEASE TYPE OR PRINT LEGIBLY - ONE FORM PER ATTENDEE)</p></td>
<td colspan="6"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="23">ATTENDEE’S NAME: (LAST, FIRST, MI)</td>
<td colspan="9">WORK PHONE W/ AREA CODE:</td>
<td colspan="4"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="8">AGENCY NAME:</td>
<td></td>
<td colspan="21"></td>
<td colspan="4"></td>
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="8">MAILING ADDRESS:</td>
<td></td>
<td colspan="16"></td>
<td colspan="14">FAX NUMBER W/ AREA CODE</td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="8">CITY:</td>
<td colspan="9"></td>
<td colspan="9">STATE:</td>
<td colspan="15">ZIP CODE + 4 CODE:</td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="2"></td>
<td colspan="24"><h2 id="seminar-selections">SEMINAR
SELECTIONS</h2></td>
<td colspan="9"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="12"><p><strong>9:00 AM – 10:30 AM</strong></p>
<p>WORKSHOPS</p>
<p>(LIST IN ORDER OF PREFERENCE)</p></td>
<td colspan="2"></td>
<td colspan="8"><p><strong>10:45 AM – 12:15 PM</strong></p>
<p>WORKSHOPS</p>
<p>(LIST IN ORDER OF PREFFERENCE)</p></td>
<td colspan="2"></td>
<td colspan="22"><p><strong>2:00 PM – 3:30 PM</strong></p>
<p>WORKSHOPS</p>
<p>(LIST IN ORDER OF PREFFERENCE)</p></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="10">1<sup>ST</sup> CHOICE</td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6">1<sup>ST</sup> CHOICE</td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="16">1<sup>ST</sup> CHOICE</td>
<td colspan="8"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="10">2<sup>ND</sup> CHOICE</td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6">2<sup>ND</sup> CHOICE</td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="16">2<sup>ND</sup> CHOICE</td>
<td colspan="8"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="28">DO YOU REQUIRE SPECIAL ACCOMMODATIONS? IF SO, PLEASE
SPECIFY: (HEARING INTERPRETER, SPECIAL DIET, ETC.)</td>
<td></td>
<td colspan="2"></td>
<td colspan="10"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="36"><h2 id="payment-registration-information"> PAYMENT
&amp; REGISTRATION INFORMATION</h2></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="11"><p>REGISTRATION DEADLINE:</p>
<p>Full registration fee is due PRIOR to conference or <strong>NO LATER
THAN</strong></p>
<h3 id="wednesday-may-12-2004">WEDNESDAY, MAY 12, 2004</h3></td>
<td colspan="8"><p>REGISTRATION FEE:</p>
<p>The fee is <strong>$99</strong> per person. Meals are included in the
registration fee.</p></td>
<td colspan="8"><p>MAIL CHECKS &amp; FORM TO:</p>
<p>IRENE WISE</p>
<p>1244 SPEER BLVD STE 903</p>
<p>DENVER, CO 80204</p></td>
<td colspan="15"><p>FAX TO:</p>
<p>IRENE WISE</p>
<p>303-844-7086</p></td>
<td colspan="5"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="11"><p>CANCELLATION POLICY:</p>
<p>Absolutely <strong><u>NO</u></strong> refunds will be given after the
closeout date of</p>
<p>May 14, 2004</p></td>
<td colspan="8"><p>RECEIPTS:</p>
<p>Available upon request <u>AT</u> the conference.</p></td>
<td colspan="8"><p>TAX ID NUMBER:</p>
<p>84-0927682</p></td>
<td colspan="15"><p>MORE INFO:</p>
<p>IRENE WISE</p>
<p>303-844-0379</p></td>
<td colspan="5"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="36"><strong>METHOD OF PAYMENT – (CHECK APPLICABLE
BOXES)</strong></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="10"><p><strong>CHECK</strong> – MAKE PAYABLE TO</p>
<p><strong><u>DENVER FEDERAL EXECUTIVE BOARD</u></strong></p></td>
<td colspan="2"></td>
<td></td>
<td colspan="2">VISA</td>
<td colspan="30">EXACT NAME ON CARD: (PLEASE PRINT)</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="10"><strong>CHARGE</strong></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"><p>MASTER</p>
<p>CARD</p></td>
<td colspan="30"><p>EXPIRATION DATE: VERIFICATION ID #:</p>
<p>(Last 3 digits on back of card by signature)</p></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="16">CARD HOLDERS PHONE &amp; FAX NUMBER:</td>
<td colspan="17">CREDIT CARD NUMBER:</td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="21">CREDIT CARD BILLING ADDRESS &amp; ZIP CODE:</td>
<td colspan="12"><p>TOTAL AMOUNT TO BE BILLED TO CREDIT CARD:</p>
<p><strong>$</strong>__________________________</p></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>