| Health and Human Services North Dakota

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First Name

Last Name

Organization

Phone

Do you need accommodations while at the training? Please describe below:

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Registration - Check One Box

Registration Choice

Employee of DPI, WSI, Tribal VR, VR, HHS, DOCR, Adult Ed, Job Service, or Community Rehab Provider

$130 per person - Registration postmarked on or before Sept. 25, 2024

$140 per person - Registration postmarked after Sept. 25, 2024

* Payment Enclosed (Checks payable to ROND) No refunds

Submit payment to:

Cheryl Anderson
Vocational Rehabilitation
1000 East Divide Ave
Bismarck ND 58501
Or email: cheanderson@nd.gov if you have any questions

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Annual Training