Registration Form - Privilege, a full day workshop
Privilege, a full-day workshop (Parts 1 and 2)
Wednesday November 6, 2019
Location: Starbridge, Andrew and Helen Pluta Training Center (Room 118), 1650 South Avenue, Rochester, NY 14620 (fully accessible)

Time: 9 am - 4 pm

Workshop fee is $95, which can be paid via check (payable to NCBI Rochester, Inc.) and mailed to:
Pat Willis
42 Menlo Place
Rochester, NY 14620
OR

Click on this link to pay online with PayPal: https://tinyurl.com/y6nm9zj4

(You must also submit the form below to register.)

Some scholarships are available due to the generosity of Excellus BlueCross BlueShield. Special rates for Groups, Students, and Seniors are also available, with prior approval.
Note: Online payment can only be used if paying full fee.

Please contact Pat Willis at willis.patricia908@gmail.com or 585-313-1047.

Registration should be received by Friday November 1.
Last Name *
First Name *
Email address *
Organization
Address
Address
City, State
Zipcode
Work Phone
Cell or home Phone (please specify)
Special Requests/Accommodations/Comments
Special rate with prior approval (Standard rate is $95)
Paying by: *
Required
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