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Homepage Brochure Return to Academic Skills Workshop Overview Registration Form (print to use)
Student_________________________________Grade_____School____________________ Address_______________________________________City_____________ZIP_________ Parent attending with the student_________________________________________________ Home Phone____________________________Work Phone__________________________ Additional student/s from the same family? If yes: Student_________________________________Grade_____School____________________ The workshop is offered on Tuesday, Wednesday, and Thursday evenings. In order to accommodate the largest number of people, please list any nights you cannot come:____________ __________________________________________________________________________ How did you learn about the Workshop?__________________________________________ __________________________________________________________________________ Signing Up: To hold your place in the next workshop, send a non-refundable deposit of $40.00 per student with this registration form. You will be notified by mail approximately one week before your workshop begins. |
| Mail to: |
| Attn: Jan |
| Salem Psychology Center |
| 2493 State Street |
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Salem, OR 97301 |
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Tel: (503) 588-1010 jan@salempsychology.com |
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Homepage Brochure Return to Academic Skills Workshop Overview |