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Event Registration

Registration fees are non-refundable. If you are a college employee, please ensure you have permission to register from your supervisor.

* Denotes required information

Please complete the form below to register for this event.

Attendee Information

*Last Name:  

*First Name:  

Middle Initial:

*Event Name:

 

Organization:  

*Position Title:  

Teaching Subject: (If applicable)

*Department:  

Dean: (If applicable)

Division: (If applicable)

*Mailing Address:  

*City:  

*State:  

*Zip:  

*E-Mail:  


Special Needs(Dietary, Accommodations, etc)

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Payment

If making payment by If making payment by credit card, please complete the credit card payment form. credit card, please complete and print the Credit Card payment form. Mail or fax checks, completed credit card forms and purchase orders fax to this address.

Attention: Marilou Christiansen
WA State Center of Excellence for Careers in Education
MS: Teach, Green River Community College
12401 SE 320th ST, Auburn, WA 98092-3622
mchristiansen@greenriver.edu
Fax: (253) 333-4961
Phone: (253) 833-9111, ext.4361