Please complete the following form to register for the 2010 CPS Technician Update

If you do NOT receive email confirmation within five business days, contact Tim Jasnoch at the Nebraska Office of Highway Safety: 402-471-2017

Your Name
Your Organization
Mailing address
City
State
Zip
Home phone
Work phone
Email (REQUIRED)
Safe Kids Technician Number
I will attend:	Tuesday March 30, 1:30-4:30 (Play Time Session) Wednesday March 31, 8-5 CPS Technical Update
Lodging needs for March 30	I am traveling 100 miles or more and request lodging (double occupancy).
Roommate request?
I prefer a private room and will pay for my own lodging	I will make my own arrangements with Holiday Inn (308-237-5971).
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