I would like to register for the Vision Specialist class to be held January 9 - May 17, 2008
(Please complete the following information)
Full Name Title/Position Organization/University Address City State Zip Code Telephone Number Fax Number Email Address Approval Signature (if required) State Agency Director
Classes fill up early so get your registration form in as soon as possible. Selected participants will be notified by December 15, 2007 and be provided with additional information. Please check if you are a person with a disability, female, or represent a minority population.
For further information, please contact: BJ Lejeune, Director bjlejeune@colled.msstate.edu Rehabilitation Research and Training Center on Blindness and Low Vision P.O. Box 6189 Mississippi State, MS 39762 FAX: (662) 325-8989