P. O. Box 872188
Wasilla, AK 99687-2188
907-376-0366 (Office)
907-376-0635 (Fax)
Name: _____________________________________________________
Organization: ________________________________________________
Mailing Address: _____________________________________________
City, State & ZipCode: _________________________________________
E-mail Address: ______________________________________________
Phone: _____________________________________________________
Training (Title): _______________________________________________
Date (s): ____________________________________________________
Dietary or Other Special Needs: __________________________________
Cost: $ __________________ ( enclose check & mail to above address). One form per person, please. Confirmation will be sent.
Scholarship needs: _____________________________________________
Please call: 907-376-0366 if you have any further questions. If you will not be able to attend the workshop on the scheduled day, call: 907-355-0669. Thank you!