P. O. Box 872188
Wasilla, AK 99687-2188
907-376-0366 (Office)
907-376-0966 (Fax)
eleanor@akattachment.org
laura@akattachment.org
Name: ____________________________________________________________
Organization/Parent: _________________________________________________
Mailing Address: ___________________________________________________
City, State & Zip Code: _______________________________________________
E-mail Address: _____________________________________________________
Phone: ____________________________________________________________
Training (Title): _____________________________________________________
Date (s): ___________________________________________________________
Dietary or Other Special Needs: _________________________________________
Cost: 150.00(Enclose check payable to: AABA, PO Box 872188, Wasilla, AK 99687). One form per person please. Confirmation will be sent.
Family Size: Adults:_________________ Children:________________________
Annual Income: $0-$25,000___ $25,000-36,000____$36,000-$50,000___Other____
Scholarship needs: _____________________________________________________
Non-refundable deposit of $25 is required to hold your seat. It will be deducted from your registration fee. Full payment: due before workshop.
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: 907-355-6692/907-376-0366 Thank you!