<p> Federal Grant Funds to Transport Elderly and Disabled Individuals and for Access to Jobs Registration Form</p><p>Registration forms must be received by no later than two business days prior to the desired workshop. Please fill out the below information and email to [email protected] or fax to 919-733-1391. If you have any questions please email Cheryl M. Leonard, MPA, at [email protected]. </p><p>Each person must complete a separate registration form.</p><p>Name: Title: Agency: Address: City, State, Zip Daytime Phone #: Fax #: Email Address: ADA Accommodations Needed: </p><p>Workshop Session Attendance (lunch will not be provided) Please indicate which workshop you will be attending: Kinston Oct. 24 (register by Oct. 20) 10 a.m. – 1 p.m. Charlotte Oct. 25 (register by Oct. 21) 10 a.m. – 1 p.m. Waynesville Oct. 27 (register by Oct. 25) 10 a.m. – 1 p.m. Leland Oct. 28 (register by Oct. 26) 10 a.m. – 1 p.m. Jamestown Nov. 1 (register by Oct. 28) 10 a.m. – 1 p.m. Elizabeth City Nov. 2 (register by Oct. 29) 10 a.m. – 1 p.m. Raleigh Nov. 4 (register by Nov. 2) 10 a.m. – 1 p.m.</p><p>ATTENTION: In accordance with NCDOT Travel Policy, “In order to qualify for reimbursement for overnight stays the travel must involve a travel destination located at least 50 miles from the employee’s regularly assigned duty station or home, whichever is less, to receive approved reimbursement. “Duty Station” is defined as the location where the employee is assigned.”</p>