Meeting the Information Requirements of the Animal Welfare Act Workshop Registration Form(Private)

OMB control number 0518-0033.

Meeting the Information Requirements of the Animal Welfare Act

2012 Workshop Registration

Print this registration form and submit via fax or mail.

_______ March 14-15, 2012
_______ May 9-10, 2012
_______ October 3-4, 2012

______ I have special needs and would like to be contacted by an AWIC representative.

In the event a workshop session is cancelled by AWIC, registrants will be notified as soon as possible.

Please note: You will receive confirmation of your registration request. If your confirmation is not received within 2 weeks, please contact the Center.


Signature

Name (print or type)

Title

Organization Name

Mailing Address

Phone

Fax

E-mail

Are you an IACUC member? ___Yes ___No

Are you an experienced database searcher? ___Yes ___No

Are you familiar with AGRICOLA? ___Yes ___No

Do you search it on ___Dialog ___BRS ___CD-ROM ___Web

What would you like to learn from the workshop?

This class is free of charge. Space is limited to 20 people. Deadline for registration is one month prior to class date.

In the event a workshop session is cancelled by AWIC, registrants will be notified as soon as possible.

Workshops will be held at the National Agricultural Library (travel information). For additional information, call (301) 504-6212.

Please fax this form to (301) 504-7125 or mail it to:

U.S. Department of Agriculture

Animal Welfare Information Center

National Agricultural Library

10301 Baltimore Avenue

Room 410

Beltsville, MD 20705-2351

Last Modified Oct. 26, 2011

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0518-0033. The time required to complete this information collection is estimated to average 5 minutes per response due to the averaging of check boxes and text fields..