<p> American Public Transportation Association Mail/Fax to: MAP 21 Capital Investment Grants (Section 5309) Meetings Department APTA Program Workshop 1666 K Street, NW Hilton Chicago 11th Floor Washington, DC 20006 Chicago, IL FAX: 202-496-4331 October 2, 2013 1:30pm – 4:30 p.m.</p><p>Workshop Registration Form</p><p>Registration: The registration fee for the FTA MAP 21 Capital Investment Grants (Section 5309) Program Workshop is $75, which There are no refunds for cancellations. You may transfer your registration includes all materials for the workshop. The registration fee is waived fee at any time to another person in your organization attending the MAP for APTA Annual Meeting registrants, but please register separately for 21 Capital Investment Grants Program Workshop. You may also register the workshop. anytime during the APTA Annual Meeting.</p><p>PAYMENT Please fill in this section. Enclose appropriate fee made payable to APTA. Registrations will not be processed without payment. ___ Complimentary – (APTA Annual Meeting Attendees) ___ $75 per person (Workshop-Only Attendees)</p><p>___ Check </p><p>BADGE INFORMATION NOTE: Please complete registrant badge information carefully to avoid incomplete/incorrect information. Attach additional list if necessary.</p><p>1.______2.______Name Name ______Nickname Nickname ______Title Title ______Company Company ______Address Address ______City, State, Zip City, State, Zip ______Tel Tel ______Fax Fax ______E-mail E-mail ______Spouse/Guest (not applicable to fellow employees) Spouse/Guest (not applicable to fellow employees)</p><p>SUBMITTED BY: Name______</p><p>Company______</p><p>Address______</p><p>City, State, Zip______</p><p>Tel:______Fax:______</p><p>Please indicate any disability requiring special accommodations:______</p>