COMMUNITY COLLEGES OF BALTIMORE COUNTY



THE COMMUNITY COLLEGE OF BALTIMORE COUNTY (CCBC)

STATE OF MARYLAND PRE-RETIREMENT PLANNING SEMINARS FALL 2012

(For Members of Participating Boards of Education, County and Local Governmental Units)

Members within 8 years of retirement and their spouses are eligible to attend the following one-day seminars which begin at 8:30 a.m. and end at 4:00 p.m. A letter of confirmation will be sent no later than seven business days prior to your scheduled date.

Please place “1” (first choice) and “2” (second choice) next to the seminar you wish to attend.

|GA __ |September 13 (Thursday) |GF __ |October 12 (Friday) |GK __ |November 5 (Monday) |

| |Harford Community College | |Department of Agriculture | |Hagerstown Community College |

| |Bel Air, MD | |Annapolis, MD | |Hagerstown, MD |

| | | | | | |

|GB __ |September 20 (Thursday) |GG __ |October 15 (Monday) |GL __ |November 14 (Wednesday) |

| |CCBC, Catonsville Campus | |CCBC, Essex Campus | |CCBC, Catonsville Campus |

| |Catonsville, MD | |Essex, MD | |Catonsville, MD |

| | | | | | |

|GC __ |September 26 (Wednesday) |GH __ |October 17 (Wednesday) |GM __ |November 19 (Monday) |

| |Prince George’s Co. RMS Building | |Mt. Saint Mary’s University | |Salisbury University |

| |Largo, MD | |Frederick, MD | |Salisbury, MD |

| | | | | | |

|GD __ |September 28 (Friday) |GI __ |October 18 (Thursday) |GN __ |December 6 (Thursday) |

| |Worcester County Government | |Howard Community College | |Harford Community College |

| |Snow Hill, MD | |Columbia, MD | |Bel Air, MD |

| | | | | | |

|GE __ |October 5 (Friday) |GJ __ |October 26 (Friday) |GO __ |December 10 (Monday) |

| |CCBC, Owings Mills Center | |Towson University | |Montgomery College |

| |Owings Mills, MD | |Towson, MD | |Rockville, MD |

|LE __ |October 10 (Wednesday) |LP __ |November 2 (Friday) | | |

| |Eastern Shore Hospital Center | |CCBC, Essex Campus | | |

| |Cambridge, MD | |Essex, MD | | |

| |(Law Enforcement Officers Only) | |(Law Enforcement Officers Only) | | |

| | | | | | |

For information call: 443-840-1632

Or email: scullip@ccbcmd.edu

SEE OTHER PAGE TO FILL OUT REGISTRATION FORM

STATE OF MARYLAND PRE-RETIREMENT PLANNING

(For Members of Participating Boards of Education, County and Local Governmental Units)

REGISTRATION FORM – FALL 2012

For information call: 443-840-1632 or email: scullip@ccbcmd.edu

Please print all information:

NAME_____________________________________________________________________________________________________

Last Suffix First Middle Initial

ADDRESS__________________________________________________________________________________________________

Number and Street City State Zip Code

EMPLOYER_____________________________________________ DATE OF BIRTH __________________________

County/City Agency (REQUIRED) Month Day Year

WORK PHONE ________________________________________ HOME PHONE________________________________

EMAIL ADDRESS ____________________________________ LAST 4 DIGITS OF SOCIAL SECURITY #_____________

ARE YOU A STATE EMPLOYEE?  Yes  No

ARE YOU A MEMBER OF THE LAW ENFORCEMENT OFFICER PENSION SYSTEM?  Yes  No

ARE YOU ELIGIBLE TO RETIRE WITHIN 8 YEARS?  Yes  No

Employee’s Signature_________________________________________ Date________________

(Required) (I authorize CCBC to release this information to the State of Maryland)

| |

|Will spouse attend? Yes_______ No_______ If Yes, please complete the following information: |

| |

|_____________________________________________________________________________________ |

|Last name First |

|Middle Initial |

Please indicate any special assistance required for a handicapped condition.___________________

________________________________________________________________________________

SUBMIT YOUR COMPLETED FORM:

EMAIL: scullip@ccbcmd.edu (must email a signed copy)

OR

FAX: 443-840-1856 or 410-780-6856 (Attention Sarah Cullip)

OR

MAIL TO: The Community College of Baltimore County (CCBC)

Pre-Retirement Planning Registration, L129

7201 Rossville Boulevard

Baltimore, MD 21237

-----------------------

For Office Use Only:

Course # MAN 969_______

Date: __________________

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