Enter the title(s) and date(s) of the workshop(s) you wish to attend                   

title:___________________________________date:_________  cost $        

title:__________________________________  date:_________  cost $        

title:___________________________________date:_________  cost $        

                                                        Enter your registrant information

name:____________________________________________________________

title: _____________________________________________________________

agency: __________________________________________________________

government department or division:____________________________________

address: _________________________________________________________

city: _____________________________  state: __________  zip: __________

phone:  (_____)_____________________ fax:  (_____)____________________

email address:  ___________________________________________________

                                                        Choose your method of payment

check or money order, please make payable to: CascadiaTraining

payment method, (circle one):   Check    Visa     Mastercard    American Express

credit card number or p.o.# _____________________________________

exp. date: ___________

signature: ________________________________________________________

sub total: $____________

10% discount for groups of six or more from the same agency: $____________

total: $____________