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U.S. National Tour Registration - 9 Strategies

US National Tour The information requested in the form below will be submitted to staff members of
the Ruby K. Payne - US National Tour.

Please Note:  This is a pre-registration action only, and does not confirm a seat in a National Tour workshop. Payment arrangements must be received and accepted by aha! Process, Inc. to reserve your seat. When your seat is reserved, you should receive a confirmation within 2 business days.
Pre-Registration Form
Please take a moment to provide the information that follows (required fields are indicated by ).
 
Workshop, Date, Location


Personal Information
Title
Mr. Ms. Mrs. Dr. 		First Name
 Middle Name
 Last Name
Email Address
Mailing Address
City
State/Province
Country
Zip/Postal Code
Home Phone
School or Organization Information
Organization or School District
School Name (if applicable)
School/Org. Mailing Address
School/Org. City
School/Org. State/Province
School/Org. Postal Code
School/Org. Phone
School/Org. Fax
Position with School/Org.
Additional Information
 
Are you attending this workshop for recertification for A Framework for Understanding Poverty?   Yes    No
 
Payment Information
Payment Method
Purchase Order # (if applicable)
Questions or request for more information: