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Workshop Registration for
Online Learning: Reading With Young Children on 9/25/2017

Fields with an asterisk (*) are required.

Registration Information: Billing Information:
Workshop Amount
$  30.00
*First Name:
*Last Name:
*Email:
*Address:
Address 2:
*City:
*State:
*County:
*County:
*Zip:  
*Telephone:
 
*First name on card:
*Last name on card:
*Address:
Address 2:
*City:
*State:
*Zip:

About You:
*Are you a child care provider/teacher?


*Are you a parent/legal guardian?

How many children do you have?

What are their ages?

What is your relationship to the child(ren)?

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