PACE Place Minnesota Parent Immersion Workshop

ONLINE registration deadline is October 31^st, 2008
For details, click on PACE Place Seminar Series - Minneapolis, MN 2008.

Seminar Dates are Saturday November 8th, 9th and 15th as well as a full day private consultation to be scheduled during November 10th to 14th.

Registration will be completed by phone with Deb Crowell after

receipt of this online notification

Step 1:  Registrant Information

Registrant #1 Information

(*required for confirmation) 

*First Name    

*Last Name   

*Phone Number: Home 

Phone Number: Cell  

*E-Mail 

Mailing Address

City   State ZIP

Registrant #2 Information

(*required for confirmation of Registrant #2)

*First Name    

*Last Name   

*Phone Number: Home 

Phone Number: Cell  

*E-Mail 

If different from Registrant #1:

Mailing Address 

City    State ZIP

Step 2:  Payment Selection

(required for confirmation)

Credit Card (Visa/MC only) #

        Expiration Date  

        Security Code (last 3 digits on back)

Check

        Amount 

 

For those preferring to pay via check, please print this form and mail in with payment to:                                     

PACE Place, Inc.                                                     

Attn: Deb Crowell                                                       

2360 SW 170^th Ave                                                 

Beaverton, OR  97006

Step 3:  Registrant Profile

(optional)

Please tell us a little about you or your family so that we can make the seminar as effective for you as possible.

1.  About you

       Parent

       Professional (please describe)

       Both

2. About your child(ren) at home or you work with (please check all that  apply)

 1-3                  M    F

 4-6                  M    F

 7-10                M    F

            11-18              M    F

3. Are you attending this conference with:

Spouse

Alone

Other

4. Have you attended a PACE Game Day or Seminar Series in the past?

Yes

No

Note:  If you are sent to an error page, check to be sure the required fields and options have been filled out. 

The required fields are:

    1) Select your Seminar (Full Day only or Workshop Package)

    2) Registration Information: First and Last Name, Home Phone and email. 

            Only the First Registrant is required.

    3) Payment Selection: Select Check or Credit Card and fill in the needed information.

Click     to complete your registration!

Please call Deb Crowell, Office Manager at 503-356-8334 x 6# if you have any further questions about the PACE Place Minnesota Parent Immersion Workshop or about PACE Place, Inc.