WORKSHOP REGISTRATION FORM UNDERSTANDING AND SUPPORTING MILITARY FAMILIES PLEASE

10 III HEMISPHERIC WORKSHOP ON OCCUPATIONAL HEALTH
AFRICA REGIONAL TRAINING WORKSHOP (ANGLOPHONE) SUPPORTING COUNTRIES
FROM IPPC SERVICES SUBJECT IPP TRAINING WORKSHOP –

SCHEDA ISCRIZIONE WORKSHOP RACCOLTA FONDI E BILANCIO SOCIALE
SWG RURAL WORKSHOP AND READING PROGRAM GUIDELINES FOR
WORKSHOP MOLECULAR PHOTOREACTIVITY ON METALOXIDE SURFACES FROM FIRSTPRINCIPLES

WORKSHOP REGISTRATION FORM

WORKSHOP REGISTRATION FORM

UNDERSTANDING AND SUPPORTING MILITARY FAMILIES

Please fill out completely so that your registration may be processed promptly.

Location: 407 Main Street, Wheeling, WV 26003


Name __________________________________________________________________

(last) (first) (middle)


Address ______________________________________________________________________________________

(city) (state) (zip)

E-mail Address ________________________________________________________________________________


Phone ____________________________________


Organization/Agency/Business/Etc. __________________________________________________


Organization/Agency/Business/Etc. City and State ____________________________________________________

Have you ever taken a course or workshop facilitated by Jeremy Harrison? No ___ Yes ___ When? _____________

.

Type of License: SOWK___ LPC ___ Other _____________ N/A _______

Please register me for the following:




Workshop Title & Date



Amount Enclosed






Understanding and Supporting Military Families Friday, Nov. 3, 2017 1:00-3:00









2 Credit Hours






TOTAL AMOUNT ENCLOSED OR CHARGED TO CREDIT CARD



$


WORKSHOP FEES…………………………………………………………………………..$25 for 2 credit hours


Registration for the workshop requires a $25 non-refundable fee, which must be paid in full on or before the day of the workshop. All checks should be made payable to Helping Heroes. Credit cards may also be used for payment.


REGISTRATION OPTIONS:


1. By mail:

Mail registration form and $25 fee to: Helping Heroes, Inc., 256 Jefferson Avenue, Moundsville, WV 26041


2. By phone:

Call the Office at (304) 810-4291and register. A payment must be made by credit card.


3. By FAX:

Fax the registration information and the fee by credit card to the Helping Heroes (304) 810-4291.


4. Payments can also be made via the Helping Heroes website, www.helpingheroesinc.org. On the homepage, click on “make a donation.” Designate the payment to “workshop.”


CREDIT CARD INFORMATION


Type of Credit Card: Visa MasterCard Discover


Credit Card Number _________________________________________Exp. Date _________ Security Code _____


Name on Card______________________________________________



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