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* 1. Name

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* 2. Agency and Address

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* 3. email address

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* 4. Which workshop date are you registering for?

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* 5. Are you a trained Nobody's Perfect Program Facilitator?

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* 6. Please send me an invoice for

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* 7. Credit Card

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* 8. Thank you for your registration. 
You will receive a confirmation email with your invoice or receipt in the next few days.  

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