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,, _. <br />�. �',*�:-'. _ :� •.�Y"� - � ; <br />'7 �' � � i i 1 � i � � I <br />' �'^'��'.ixii,�f =`��� � . . _ .�'.c— ' -- — ;} ;i 1c J <br />Till Victory is Wan: Cammemorating the 50th Anniversary af the Mirtnesota Human Righ#s Aci <br />Human Rights Day 2005 Registrat�on Forrn <br />Yes, I plan to attend the 22r�d Annual Minnesota Human Righ#s �Day Conference on Friday, Dec. 2, <br />2005 at the Saint Paul RiverCen#re. <br />Please arint or #v�e <br />Name <br />Gom an /or anization <br />Address <br />Suite floor or other address <br />Citv 5tate Zip <br />Phane - include.area code <br />Note: If yau have a disability and need a reasonable accammodation to participate in this conference, or if <br />you have special dietary requirements, please cantact Denise Romero-Zasada at 651-297-2824. All requests <br />must be submitted by November 21, 2005. <br />�;y,�,,� � r� . , � ��'� <br />--` � �' � i � �--�—�. � i�' _�_' ►i� r'�� � r i ; R, . , <br />�$150 far the full registration price (nate: �o discounts for haff-day attendance) <br />�$ _for the special $120 per person Ta61e/Group rate. (Register eigF�t peaple or mare at the <br />same time, and receive this special discount and a table reserved in your organization's name. Must <br />register by I�ov. 21, 2UOS.) <br />Name of organizat�an (for tahle sign) <br />' � .1' F' . —s;' : r �, L t *y . <br />� _ L � , �, ��t� ,��::��►men# et � � ..r — _ -! _ <br />Include purchase arder number ar MAPS Transaction number helow <br />� Enclased is my check for the total amount due. <br />�*Payment has been electronically transferred. Transaction # <br />(list agency and staff attending in MAPS payment!) <br />Mail this arder form with your check, made payable to the Minnesata Departmeot of Human Rights, or your <br />P.O. to: Minnesota Deparfinent of Human Rights, Attn: Conference 2005, Sibtey Square at Mears Park, <br />490 �. 5th Street, Suite 700, St Paui, MN 551D1. Registraiion fee can be refunded if registration is cancelled before <br />the November 21 registraiion deadline; no refunds thereafter. <br />Yoa may aisa regisier online if paying by elecironic transfer. Visit aur web site at www.humanrights:state.mn.us <br />far an online nrder form and more conference informatinn. <br />'"Staie emplayees paying electronically: Use the foElawing payment information: For GFS, use Fund: 200, Agency <br />Codc: G17, Org. No: 274fl, Appropriatians: SEM, Revenue Source Cade: 870Q, ar AGPS: Vendor # 200U35981-DQ. <br />Flease state attendee's name on payment. <br />Conference to be held Friday, December 2, 20D5 at Saint Paul RiverCentre,175 West Kellogg Baulevard, Saint <br />Paul, MN, 55iQ2. <br />! 1 i + � r F° i� 1 e'i {� t �� Y! �� j� <br />