Fillable Darrel Lang Workshop Registration Form (University of Wyoming)

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Darrel Lang Workshop Registration Form (University of Wyoming)

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Registration Form
Meeting the Needs of Special Education Students in
Human Sexuality Education
April 19-20, 2018 at the University of Wyoming
-------------------------------------------------------------------------------------------------------------------------------
NAME: _______________________________________________________________________
ADDRESS: ____________________________________________________________________
CITY: _________________________ STATE: ________________ ZIP CODE _________________
Email address: _________________________________________________________________
Step 1: Please scan your registraon and send it via email to Dr. Lang: dlkansas@gmail.com
This will allow Health Endeavors to make sure that payments match registraons.
Step 2: Then mail the registraon form with the check or purchase order to Health Endeavors at
the address below:
Payment: $195 (includes workshop materials)
____ Check (Number: ____________ ) or ____ Purchase order (Number: ______________)
Make payments payable to: Health Endeavors: Consulng and Training, LLC
c/o Dr. Darrel Lang - President
P.O. Box 2316
Emporia, KS 66801
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Darrel Lang Workshop Registration Form (University of Wyoming)

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Completed 18 July 2020

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