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Course Registration

Personal/Agency Information

Required for all attendees

First Name

Last Name

Email

Phone Number

PID

Agency Name

Agency Address

City

State

Postal Code

Course Name

Course Location

Payment Type

Credit, Check, or Other (please specify). Attendees can pay via PayPal after submitting this form.

List Other Attendees Names/Emails

If registering multiple attendees from same agency:
List each attendee’s name, email and phone number. If paying via Paypal please change the quantity when registering for multiple people.

Cancellation Policy