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WORKSHOP REGISTRATION

Course:

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Email:

First Name:

Last Name:

Cell Phone:

Allow Texts:

Country:

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Country (Other):

Home Province/State:

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Home Postal Code/ZIP:

Hear of Us:

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Hear (Other):

Organization:

Division/Area

Role

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Role (Other):

About you...

Work Challenges:

Challenges this year:

Participation Agreement

Media Release

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