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<br />Minnesota Building Codes and Standards <br /> <br />Page 1 of 1 <br /> <br />(print ang maillhis form to the address below) <br /> <br /> 2005 Fall Seminar: Residential Plan Review <br /> Registration Form <br />Please clea. lI'ItvDe or DrintDne reaistrant Der forml <br />Name: 'A-t ./1_ UArl .,.~ 11 <br />ertification II if aDDlicablel ;'!:;7?. <br />Emplover { ~'fo" /} Ce-Jre/'I/j.L .p <br />dd ress V1"2 ') .M.4.-~ ..~ 'Yf <br />City/State/ZiD r ........- 101.,J ~ "Z>)K <br />Phone IL:JC -qz-~ - q; '.'\to <br />Email Address (print clearly) <1 '1M z..,ef e CJ;?-r-r'e-/Vr. CW"-J. c.L'>P\ <br />fJ Please put me on your mailing list for future seminars. <br />Registration fee is $35/person. Registrations received later than 10 days prior to the seminar <br />will NOT be accepted. <br /> heck # Amount $ <br />Purchase Order # Amount $ <br />Please make checks payable to State Treasurer. <br /> using a purchase order, please attach a copy. <br />tate employees use Building Codes & Standards vendor # 20001891226 <br />tate Deposit # <br />ndicate choice ofseminaryou wish to attend: <br /> Oct. 4, Burnsville Nov. 1, Brooklyn Center <br />~< j?-::,. <br /> Oct. 6, Maplewood Nov. 3, Rochester <br /> Oct. 12, Detroit lakes Nov. 9, Duluth <br /> Oct. 18, Plymouth Nov. 15, Bumsville <br /> Oct. 20, 51. Paul Nov. 17, N. Mankato <br /> Oct. 26, St. Cloud I~ Nov. 22, Maplewood <br />I have the following special needs: <br />Mail to: Building Codes and Standards Division <br />~08 Metro Square Bldg., 121 7th Place East <br />SI. Paul, MN 55101-2181 <br />Questions: Voice (651) 296-4628, Toll Free 1-800-657-3944, <br />TTY: Minnesota Relay 711 <br />Fax (651) 297-1973 <br />Web-site: http://www.doILstate.mn.us <br /> <br />http://www.state.mn.us/cgi -bin/portal/mn/j sp/common/ content/include/ contentitem.j sp ?contentid=5 3 69060... 8/312005 <br /> <br />)1 <br />