Capacity Building Training Registration
March 5, 2013
8:00-12:00
Kings Inn Hotel & Conference Center
Pierre, SD

* 1. Name

* 2. Work Phone

* 3. Partnership/School/Coalition/Agency Name

* 4. Address

* 5. City/State

* 6. Zip Code

* 7. Email

* 8. Home/Cell Phone (in case of inclement weather)

* 9. What kind of scholarship are you requesting? Please check all that apply.

* 10. Will you be staying for a free lunch that will be served immediately following the training?

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