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William Brennan Institute for Labor Studies

 


~ ~ ~ REGISTRATION FORM ~ ~ ~

You may Complete this Form, Print Page, then FAX or MAIL.
PHONE: MAIL: HAND DELIVER:
Office: 402-595-2344
(M-F 8-5pm)

Fax: 402-595-2321 (24 Hours)
William Brennan Institute for Labor Studies
6001 Dodge Street, PKCC 233G
University of Nebraska at Omaha
Omaha, NE 68182-0531
Peter Kiewit Conference Center
1313 Farnam Street - Rm 233G
Omaha, NE
PARTICIPANT INFORMATION: PRICES: PGW Conference #B14-0405-O
Name: Students:
Early Enrollment $25 through March 28, 2014 else $35
Home Address: I am a student at:
Home City: Home State: Home Zip: Please consider me for a Scholarship
Email: General Public:
Early Enrollment $35 or $45 after 3/28/14
Daytime Phone: PAYMENT OPTIONS:
Union Name & Local #: Bill my Union Cash
Union Address: Checks
(Payable to University of Nebraska at Omaha
Union City: Union State: Union Zip:
This conference is a public event and use of event photos allows the William Brennan Institute for Labor Studies to extend the influence of the event throughout the year. Event photos are used for publicity, an in a variety of other educational efforts. Participation in the event is an assumption of agreement to be photographed.
Union Phone:
My preferred mailing address is: Home Union I am requesting CEUs