DOMESTIC VIOLENCE IN THE WORKPLACE

Participant Registration Form

Summit will be held October 30, 2003

                                                                S P A C E     I S     L I M I T E D!!!!!

           Summit Registration Fee: $50.00    

           Vendor Display Fee: $75.00 

Advertising in Day of Event Program

           I am interested in purchasing a:                       

       ___ Full Page Ad in Program  $250.00        

       ___ Half Page Ad in Program $100.00  

Special Non-Profit Rates

       ___ Full Page Ad in Program $100.00

       ___ Half Page Ad in Program $  35.00 

                     TOTAL AMOUNT ENCLOSED:    $________

       Please select the afternoon workshop of your choice:

       Workshop #1: 2:00-3:00pm (choose one)                        

       ____North Carolina Laws       

       ____Model Policies for the Workplace                        

       ____Prevention in the Workplace

       Workshop #2:  3:00-4:00pm (choose one)  

       ____Best Practices: Employer to Employer

       ____Accessing Local Resources:  Who Can Help?

       ____Responding to the Cultural and Linguistic Needs of Victims

       Please send your check (made payable to the NCCADV),

for registration, vendor, and advertising,

 along with this registration form to:

North Carolina Coalition Against Domestic Violence

115 Market Street Suite 400

Durham, N.C.  27701

Please make a copy of this form for your records.

Refund Policy:  No refunds will be offered,

however, substitutions are allowed.  

**Deadline for registration:  October 10, 2003