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* Organization Name

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* Role within the organization

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* First Name

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* Last Name

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* Phone

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* Email

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* Address 1

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* Address 2

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* City

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* State

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* Zip Code

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* Choose Workshop Location

Registration is $25, which includes lunch and 6 CE Credits.

You can pay at the door or pay online here. 
Online registration is $25 plus a $2 PayPal Fee
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