By completing the questions below you are registering to attend the Making Proud Choices workshop scheduled for November 15, 2017 from 8:30-3:30. This workshop will be held at the Merchant's Millpond State Park located at 176 Millpond Road Gatesville, NC 27938.
Lunch will be provided and your school will be reimbursed for substitute expenses.

Question Title

* 1. First Name:

Question Title

* 2. Last Name:

Question Title

* 3. Position/Title:

Question Title

* 4. School District/Organization:

Question Title

* 5. School/Agency:

Question Title

* 6. Street Address:

Question Title

* 7. City:

Question Title

* 8. State:

Question Title

* 9. Zip Code:

Question Title

* 10. Email:

Question Title

* 11. Phone Number:

T