Workshop Registration Form

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Workshop Registration
Name:
Date:
DOB:
Gender:
Company:
Position:
Email:
Phone:
Address:
Workshop Name:
Led by:
Date(s):
Time(s):
Building:
Room:
Equipment Required:
Disabilities/Special
Requirements:
Previous Education/Experience:
Where did you hear about the workshop?
q Social Media
q Friends
q School
q Flyer
¨ Option 1:
¨ Half-Day
$
¨ Full Day $
¨ Option 2:
¨ Half-Day
$
¨ Full Day $
¨ Option 3:
¨ Half-Day
$
¨ Full Day $
¨ Option 4:
¨ Half-Day
$
¨ Full Day $
¨ Member Discount: $
Membership No.
TOTAL
$
¨ Check ¨ Cash ¨ Card ¨ Paypal
Acct./Card No.
Exp.
Terms and Conditions
Signature
Date

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