CCA Exam Prep Course REGISTRATION
January 8-9, 2020 @ the Purdue DTC
View the AGENDA here: https://bit.ly/2BuXaw6
Email address *
Registrant Name (Last, First) *
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Home Address *
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Business Name (if applicable) *
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Registrant Contact Phone # *
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Please complete the following: *
Yes
No
I require auxiliary aids / services due to a disability.
Digital photographs may be taken of the speakers and audience at workshops. Please check yes, to let us know that you agree to have your photo taken if applicable.
I have a dietary restriction and will need special accommodations.
Please list your dietary restriction here (if any)
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Choose your payment method - note pre-payment is required to hold your place for this course. *
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