NEW MOTOR VEHICLE BOARD

INDUSTRY ROUNDTABLE REGISTRATION FORM

THURSDAY, APRIL 10, 2014 8:30 a.m.

Department of Motor Vehicles

Assembly Room - 6th Floor

2415 First Avenue

Sacramento, California 95818

*** Roundtable Topics ***

There is no cost to attend the New Motor Vehicle Board Industry Roundtable.

Parking is available, but limited. If you will require a parking space, special accommodations, or need any additional information, please contact Eugene Ohta at (916) 445-1888 or nmvb@nmvb.ca.gov.

Registration Information - Fields with '*' are required entries.


*Name


Title or Exact Position


*Company Name


*Address


*City

*State:  *Zip: 

*Phone:   Fax: 

*Email:     

*Confirm:   (confirm email address)
*Modify your name as you wish it to appear on your badge: