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Massachusetts Service Alliance Event Registration Form

Thank you for your interest in Massachusetts Service Alliance’s upcoming trainings and events! Please complete the information requested below and click “submit.” In order to properly complete your registration, be sure to click through all of the pages back to the thank you page, which will serve as a confirmation that your registration was successful. You will receive a confirmation of payment and further event details once your registration is processed by the Massachusetts Service Alliance.

Payment information
Payment information will be requested on the next page. By registering online via our secure server, you can use a purchase order or credit card or send us a check to make your payment. On the payment information page, please be sure to enter the contact information for the person whose name appears on the credit card, if it is different than the registration contact information.

Please complete a separate form for each individual.

Contact Information:
Name
Job Title
Organization
Address
City
State
Zip
Telephone
Fax
E-mail

Please select the event for which you wish to register:

2010 SPRING TRAINING DATES
Developing Youth- and Family-Friendly Service Day Projects Friday, March 12 - City Year Headquarters, 287 Columbus Avenue, Boston Fee: $30 (includes continental breakfast) Check here if you are an AmeriCorps State or National Direct, Commonwealth Corps or MSA Funded Mentoring Program staff or service corps member. Please also check the applicable box below to receive your fee waiver. Please check the appropriate program: AmeriCorps State / National Corps member Supervisor or other staff member Commonwealth Corps Corps member Supervisor or other staff member 2009-10 MSA Funded Mentoring Program Staff

Professionalizing Volunteer Roles for Leadership Development Wednesday, April 7 - Brandeis University, Heller School, 415 South Street, Waltham Fee: $30 (includes continental breakfast) Check here if you are an AmeriCorps State or National Direct, Commonwealth Corps or MSA Funded Mentoring Program staff or service corps member. Please also check the applicable box below to receive your fee waiver. Please check the appropriate program: AmeriCorps State / National Corps member Supervisor or other staff member Commonwealth Corps Corps member Supervisor or other staff member 2009-10 MSA Funded Mentoring Program Staff

BE SAFE: A Holistic Approach to Prevention Services for Youth Wednesday, April 28 - AIDS Action Committee, 75 Amory Street, Boston Fee: $30 (includes continental breakfast) Check here if you are an AmeriCorps State or National Direct, Commonwealth Corps or MSA Funded Mentoring Program staff or service corps member. Please also check the applicable box below to receive your fee waiver. Please check the appropriate program: AmeriCorps State / National Corps member Supervisor or other staff member Commonwealth Corps Corps member Supervisor or other staff member 2009-10 MSA Funded Mentoring Program Staff

Leadership & Vision: Understanding Opportunities under the Serve America Act (This Event is for Current Grantee programs only) Thursday, April 15 – Sturbridge Host Hotel No registration fee. There will be a $20 charge for “no-show” or cancellation less than one week before the event. You may substitute another staff member (not a corps member.) Please check the appropriate program: AmeriCorps State AmeriCorps National Direct (operating in MA) RSVP Foster Grandparent Program Senior Companion Program Other


*Fees will be waived for staff and service corps members from Massachusetts AmeriCorps State or National Direct programs, 2009-10 MSA-funded mentoring grantee programs; or Commonwealth Corps programs. To receive these waivers please complete the appropriate section of the registration form. To receive the fee waiver you must identify your fee-waived program and indicate whether you are a staff or corps member."No-show" fees may apply without proper notice of cancellation. See your confirmation memo for details. In case of severe weather emergencies, workshops may need to be rescheduled or cancelled. For update information call 617-542-2544, x218. Facilities are accessible to wheelchairs. To request another accommodation, (e.g. CART service, large print materials) please contact Naomi Weiner at 617-542-2544, x218 or nweiner@mass-service.org
Payment by Check If mailing a check, send to: Massachusetts Service Alliance Attention: Training Registrar 100 N. Washington Street, 3rd Floor Boston, MA 02114

Special Accommodations Required (if applicable):

© 2010 Massachusetts Service Alliance
100 North Washington Street, Third Floor, Boston, MA 02114
P: 617.542.2544 F: 617.542.0240