WORKSHOP REGISTRATION FORM
 
Use only for Contra Costa SELPA sponsored events.
Name: Position/Title:
LEA/District: Site:
Phone: Email:
Workshop Name/Date:
For AT Training on 3/8:
Registration Fee:
Method of Payment: check* purchase order p.o.#
Additional Registrants (if any):  
Name: Position/Title:
Name: Position/Title:
   
Additional Information (if required):  

Please help us prevent SPAM and enter the code as it is shown:


Due to the possibility of technical difficulties, we suggest you follow up your online registration with a telephone call or email message to confirm its receipt. Contact Lisa Ambrosini at 925-827-0949 x10.
Please read the following information:

We do not have the capability to accept payment by credit card.

*If you have indicated you will pay by check, please remit payment to:

Contra Costa SELPA 2520 Stanwell Drive, Suite 270 Concord, CA 94520.

Be sure to include with your payment the name and date of the workshop for which you have registered.

If you have any questions, want to confirm or cancel your registration, please contact Lisa Ambrosini at (925) 827-0949, ext. 10.

Workshops may reach capacity early or be cancelled due to lack of registration. Please register early to guarantee your spot.

72-hour cancellation notice is required for refund, unless otherwise noted. Substitutions are welcome, please call in advance.