Workshop Registration Form

Please fill out the information below to register for a workshop. 

The fee for each of the Alliance Alive! Workshops (Multiple Intelligences)  is $50.00 and includes .5 CEU credit at no extra charge.

        Please note that registration is not complete until fee is paid.

All items marked with an asterisk (*) are required fields.

First Name*     Middle Initial     Last Name*

Address*
Address Two
City*      State*      Zip*

Phone
Email Address*

Which workshop would you like to attend? (please check appropriate box)*

(If you wish to register for both workshops, please click the submit button once for the first one, then return to this form and re-register (resubmit) for the other.  Please check only one box each time.)

Alliance Alive! Workshop I (Multiple Intelligences)-USM-Hattiesburg

Alliance Alive! Workshop II (Multiple Intelligences)-Ole Miss-Oxford

Last day to register for Alliance Alive Workshop I (Multiple Intelligences) in Hattiesburg: 03/18/2003

Last day to register for Alliance Alive Workshop II