Online Registration Form
for the Cal/Neva Learning Institutes

Items with an asterisk are required fields. We cannot process registration without this information.

*Registrant 1 First Name: Last Name:
*Registrant 1 Job Title:

 Registrant 2 First Name: Last Name:
 Registrant 2 Job Title:

 Registrant 3 First Name: Last Name:
 Registrant 3 Job Title:

 Registrant 4 First Name: Last Name:
 Registrant 4 Job Title:

 Registrant 5 First Name: Last Name:
 Registrant 5 Job Title:


 *Agency Name:

 *Mailing Address:

 *City, ST, Zip:

 *Telephone:   Fax:

  E-mail address:

Registration. Please register the individual above for:

Cal/Neva Learning Institute, Thursday February 23, 2012 in San Francisco. $35 includes refreshments and lunch.

Please indicate the tracks the registrant will attend:

 9:30a: ROMA- Undecided Yes No    Board Governance- Undecided Yes No    Program Delivery- Undecided Yes No

11:10a: ROMA- Undecided Yes No   Planning & Assessments- Undecided Yes No   Financial Accountability- Undecided Yes No

 2:10p: ROMA- Undecided Yes No   Leadership & Administration- Undecided Yes No    Evaluation- Undecided Yes No

 3:40p: ROMA- Undecided Yes No   Capacity Building for Rural CSBG Entities- Undecided Yes No


Payment Options.

 Purchase Order (if not prepaid, add $10 billing & handling fee)
     P.O. Number:

 Invoice Us (if not prepaid, add $10 billing & handling fee). To whom should we send the bill if different from above?
The Invoice option is for Agencies only. Individuals, please call 510-339-3801 with your credit card info, or mail a check.

We are mailing a check, made payable to Center for Community Futures. EIN #68-0162602.

Charge to credit card.  Call 510-339-3801.

Payment to be made onsite.


If you have any questions or special requests regarding the Cal/Neva Learning Institutes, please let us know and we will respond promptly: