The Animal Welfare Act Workshop Registration Form (State, Local, or Tribal Government)

OMB control number 0518-0033.

Meeting the Information Requirements of the Animal Welfare Act

2018/2019 Workshop Registration

_______ October 11-12, 2018

_______ March 13-14, 2019

_______ May 15-16, 2019

_______ October 2-3, 2019

In the event a workshop session is cancelled by AWIC, registrants will be notified as soon as possible.

Please note: You will receive confirmation of your registration request. If your confirmation is not received within 2 weeks, please contact the Center.

When you register for the workshop using this form, you are voluntarily providing the information. We use this information to correspond with you about the workshop and to follow-up on any questions. If provided, personally identifiable information is maintained in a spreadsheet that is regularly purged after 410 days.

Name:

Title/Position (Current Profession):

Organization Name:

Years Working in a Research Setting Involving Animal Work:

Highest Level of Education:

Work Address: city, state, country

Work Phone:

E-mail:

Are you an IACUC member? ___Yes ___No

If so, what is your role? __________________________

Are you a principal investigator? ___Yes ___No

Are you an experienced database searcher? ___Yes ___No

What would you like to learn from the workshop?

For more information, contact:

Animal Welfare Information Center

U.S. Department of Agriculture

Agricultural Research Service

National Agricultural Library

10301 Baltimore Avenue

Beltsville, MD 20705-2351

Email: [email protected]

Phone: (301) 504-6212

Fax: (301) 504-5181

Last Modified March 15, 2018

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0518-0033. The time required to complete this information collection is estimated to average 5 minutes per response due to the averaging of check boxes and text fields..