Learning Academy Registration
September 2020 - May 2021
Organization Name *
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First Name *
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Last Name *
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Title
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Email Address *
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Street Address *
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City *
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Zip Code *
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Phone Number *
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What topics do you think are especially important to cover in our workshops this session?
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Have you submitted Payment for the Learning Academy 2020 - 2021? Annual fee is $500. If not, please either pay by check or complete payment here: https://amplifymissionne.securepayments.cardpointe.com/pay (opens in new tab) then return to this form to complete. *
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