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* 1. Name

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* 3. Phone number

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* 4. Shipping address for training materials.

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* 5. Organization/Business name if shipping to an office. (If you are shipping to your home office, a response is not needed on this question)

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* 6. Grant.

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* 7. I understand I must attend both days of training. If I miss any part of the training or have to cancel my registration, it is my responsibility to mail the materials back to Youth Connections at my/my agency's own cost. Failure to do so will result in a $100 fee for material printing and shipping.

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