{"id":657,"date":"2023-03-27T21:16:02","date_gmt":"2023-03-27T21:16:02","guid":{"rendered":"https:\/\/ccswpms01.ua.edu\/governors\/?page_id=657"},"modified":"2025-09-05T21:39:36","modified_gmt":"2025-09-05T21:39:36","slug":"register-by-mail","status":"publish","type":"page","link":"https:\/\/ccswpms01.ua.edu\/governors\/register-by-mail\/","title":{"rendered":"Register by Mail"},"content":{"rendered":"

National Title IV-E Roundtable<\/h2>\n
\n
\n

Printable form – Use your browser\u2019s Print icon to print<\/p>\n

CS-2505-NTIVER-01<\/p>\n

Mail To:
\nRegistration Services<\/strong>
\nThe University of Alabama
\n<\/strong>Box 870388<\/strong>
\nTuscaloosa, AL 35487<\/strong><\/p>\n

Email To:\u00a0<\/strong>
\nRegistration_Services@ua.edu, along with a copy of your company Purchase Order.\u00a0<\/strong><\/p>\n

 <\/p>\n

Please submit this entire page for your registration. For multiple registrations, please duplicate this form.<\/p>\n

[ ]Mr. [ ]Ms. [ ]Dr. First:____________________________Middle Initial:________Last:____________________________<\/p>\n

Preferred Name\/Nickname:____________________________<\/p>\n

Company\/Organization Name:____________________________<\/p>\n

Mailing Address:____________________________City:____________________________State:________Zip:______________<\/p>\n

Email Address:____________________________Phone:____________________________<\/p>\n

Job Title:____________________________<\/p>\n

[ ] Enclosed is a check for $____________________________ made payable to THE UNIVERSITY
\nOF ALABAMA<\/p>\n

[ ] Purchase order is attached.<\/p>\n

[ ] Charge $____________________________to credit card: [ ] MasterCard [ ] VISA [ ] American Express [ ] Discover<\/p>\n

Card #____________________________Exp. Date (M\/Y)____________________________<\/p>\n

Security \/ Verification \/ CVV Code____________________________(Three or four digit code on back or front of credit card.)<\/p>\n

Authorizing Signature:____________________________<\/p>\n

Participant Registration:<\/h2>\n

[\u00a0 ]\u00a0 $595 – Early Bird, must register by June 30, 2025<\/p>\n

[\u00a0 ]\u00a0 $645 – Standard rate after July 1, 2025<\/p>\n

[\u00a0 ]\u00a0 $535.50 -Early Bird Group Rate, must register by June 30, 2025 (Available for companies or organizations sending 3 or more people. Registrations must be submitted at the same time to qualify.)<\/em><\/p>\n

[\u00a0 ]\u00a0 $580.50 -Early Bird Group Rate, after July 1, 2025<\/p>\n

Pre-Conference Workshop Registration:<\/h2>\n

[\u00a0 ]\u00a0 $250 –OSHA Lockout\/Tagout\u00a0<\/span><\/p>\n

[\u00a0 ]\u00a0 $250\u00a0 Sampling Workshop for Industrial Hygiene and Workplace Safety<\/p>\n

[\u00a0 ]\u00a0 $250 –OSHA 7105 Evacuation and Emergency Planning\u00a0<\/span><\/p>\n

Note: The University of Alabama is committed to complying with the Americans with Disabilities Act. Requests for accommodation of physical and\/or dietary needs should be made at least 30 calendar days in advance of the program date. Please email your request to professionaldevelopment@ua.edu.<\/p>\n

Need our STAARS Vendor Number? Please use VC000118827 for UA Office of Teaching Innovation and Digital Education.<\/p>\n

A portion of the invoice amount for this program will go to the Capstone Lifelong Learning Foundation to support activities of The University of Alabama and the Office of Teaching Innovation and Digital Education.<\/p>\n

Questions? Contact Amanda Bergeron at professionaldevelopment@ua.edu or call 205-348-9966<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

National Title IV-E Roundtable Printable form – Use your browser\u2019s Print icon to print CS-2505-NTIVER-01 Mail To: Registration Services The University of Alabama Box 870388 Tuscaloosa, AL 35487 Email To:\u00a0 Registration_Services@ua.edu, along with a copy of your company Purchase Order.\u00a0   Please submit this entire page for your registration. For multiple registrations, please duplicate this […]<\/p>\n","protected":false},"author":38,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-657","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\nRegister - Governors Copy<\/title>\n<meta name=\"description\" content=\"Complete the printable form to register by mail to attend the 2023 Alabama Governor's Safety and Health Conference.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Register - Governors Copy\" \/>\n<meta property=\"og:description\" content=\"Complete the printable form to register by mail to attend the 2023 Alabama Governor's Safety and Health Conference.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/ccswpms01.ua.edu\/governors\/register-by-mail\/\" \/>\n<meta property=\"og:site_name\" content=\"Governors Copy\" \/>\n<meta property=\"article:modified_time\" content=\"2025-09-05T21:39:36+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/ccswpms01.ua.edu\/governors\/register-by-mail\/\",\"url\":\"https:\/\/ccswpms01.ua.edu\/governors\/register-by-mail\/\",\"name\":\"Register - 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