Facilitators Training Event
OCTOBER 12-15, 2010
DUNCAN CONFERENCE Center - DELRAY BEACH, FL

Training Event Registration Form

* Be sure to print a completed copy of this form for your records before submission.*

 

First Name
Last Name
Email Address
Phone Number
(Format: 999-999-9999)
Preferred name for nametag
Diocese
What is the status of your diocesan Fresh Start Program? (check all that apply)
What is your anticipated role with Fresh Start in your diocese?
What is the name and email address of your Diocesan Fresh Start coordinator/contact person?
Preferred Mailing Address:
Address:
Phone (Work/Day)
Phone (Cell)
Phone (Fax)
I have the following dietary restrictions, allergies, special needs:
Have you attended a Fresh Start training event in the past? If yes, where and when?
If you have served as a facilitator or coordinator in the past, list when and where:
If you have been a participant in a diocesan program, list when and where:
If you are clergy, what is your ordination date?

A $1,200.00 fee is required (You can pay online or in person)

Please answer the simple math question below to submit the form.
2 + 2 =

Be sure to print a copy of this form for your records before submission.
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