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Outreach Programs > Professional Development > Workshops > Registration

Workshop Registration

Salutation:


Full Name:


Home Phone:

Home Address:

Home City:

Home State:

Home Zip:

Home e-mail:


School District:

Current School:

School Address:

School City:


School State:


School Zip:


School Phone:

School Fax:

School E-mail:

Current Teaching Assignment (Please check all that apply):

Regular Classroom Grade Level: Content Area:
Resource Inclusion Grade Level:
Administrative Elementary Middle Secondary
Other:

Educational Background: (Please check all that apply):

Undergraduate Graduate Experience working with LD/ADHD students

Would you like a vegetarian meal?:

Yes  



I would like to register for:

Payment Type:

Please make checks payable to The Hill Center, Inc. and mail to 3200 Pickett Rd, Durham NC 27705 attn: Pam Hoggard. Credit card users - please call Pam Hoggard at 919-489-7464 with your credit card information.

Note: Cancellation of registration must be received 10 days in advance of program and must be accompanied by the registration receipt. There will be a $50 charge for cancellation.

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