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.
First Name:

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* 1. First Name:

Last Name:

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* 2. Last Name:

Position/Title:

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* 3. Position/Title:

School District/Organization:

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* 4. School District/Organization:

School/Agency:

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* 5. School/Agency:

Street Address:

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* 6. Street Address:

City:

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* 7. City:

State:

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* 8. State:

Zip Code:

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* 9. Zip Code:

Email:

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* 10. Email:

Phone Number:

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* 11. Phone Number:

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