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<br />Registration Deadline: November 21 <br /> <br />Till Victory is Won: Commemorating the 50th Anniversary of the Minnesota Human Rights Act <br /> <br />Human Rights Day 2005 Registration Form <br /> <br />. <br /> <br />Yes, I plan to attend the 22nd Annual Minnesota Human Rights Day Conference on Friday, Dec. 2, <br />2005 at the Saint Paul RiverCentre. <br /> <br />Please orint or tvoe <br /> <br />Name <br /> <br />Company/organization <br /> <br />Address <br /> <br />Suite. floor or other address <br /> <br />City <br /> <br />State <br /> <br />Zio <br /> <br />Daytime Phone - include area code ( <br /> <br />Note: If you have a disability and need a reasonable accommodation to participate in this conference, or if <br />you have special dietary requirements, please contact Denise Romero-Zasada at 651-297-2824. All requests <br />must be submitted by November 21, 2005. <br /> <br />Amount Due (Pre-payment is required) <br /> <br />D $150 for the full registration price (note: no discounts for half-day attendance) <br /> <br />D $_for the special $120 per person Table/Group rate. (Register eight people or more at the <br />same time, and receive this special discount and a table reserved in your organization's name. Must <br />register by Nov. 21, 2005.) <br />Name of organization (for table sign) <br /> <br />. <br /> <br />Payment Method <br /> <br />Include purchase order number or MAPS Transaction number below <br /> <br />D Enclosed is my check for the total amount due. <br /> <br />D *payment has been electronically transferred. Transaction # <br />(list agency and staff attending in MAPS payment!) <br /> <br />Mail this order form with your check, made payable to the Minnesota Department of Human Rights, or your <br />P.O. to: Minnesota Department of Human Rights, Attn: Conference 2005, Sibley Square at Mears Park, <br />190 E. 5th Street, Suite 700, St. Paul, MN 55101. Registration fee can be refunded if registration is cancelled before <br />the November 21 registration deadline; no refunds thereafter. <br /> <br />You may also register online if paying by electronic transfer. Visit our web site at www.humanrights.state.mn.us <br />for an online order form and more conference information. <br /> <br />*State employees paying electronically: Use the following payment information: For GFS, use Fund: 200, Agency <br />Code: G17, Org. No: 2740, Appropriations: SEM, Revenue Source Code: 8700, or AGPS: Vendor # 200035981-00. <br />Please state attendee's name on payment. <br /> <br />Conference to be held Friday, December 2,2005 at Saint Paul RiverCentre, 175 West Kellogg Boulevard, Saint <br />Paul, MN, 55102. <br /> <br />. <br /> <br />Conference questions? Call 651-296-5996 or call 1-800-657-3704 and press 302. <br />