JLCP Workshop Registration and Membership Form
For workshops requiring payment:
To officially register for a workshop, your payment must be received by the registration deadline. If we haven't received your payment before the deadline, we will provide one courtesy call to remind you that it's coming up. After the deadline, your seat will be opened up for someone else.

If you have any questions please call 782-4900 ext 239. Thank you for your interest and support!

Your name *
Your answer
Complete address *
House Number or PO Box, Street, City, State and Postal Code
Your answer
Phone *
Your answer
Your answer
Would you like to receive news, information, and updates from JLCP by email?
In what capacity are you currently working with children? *
Choose the best answer
Program Name
Your answer
How did you hear about the workshop(s)?
Which workshop(s) would you like to register for?
For any training requiring a fee, you will not be fully registered until payment is received. Payment deadline for all Heartsaver courses is the Friday TWO WEEKS prior to the training date.
JLCP Membership (optional)
Your membership fees help JLCP offer support and recognition to child care providers in Jefferson and Lewis Counties, such as Provider Appreciation Day events and provider networking activities.

Membership is valid for one year from month of purchase.

I wish to purchase
For any workshop charging a fee, payment must be received by deadline stated above.
Accepted payment: cash, check payable to CAPC, money orders, purchase orders and EIP Award Notice.
For JLCP membership purchases ONLY
Accepted payment: cash, check payable to CAPC, money orders, and purchase orders.
Total of payment you are making to Community Action Planning Council
Your answer
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