ASIST Registration Form
Thank you for your interest in the ASIST workshop hosted by Foundations Counseling and Consultation Services and facilitated by Paige Hirt and Monica Parmley. The workshop will take place at Lakewood Center for the Arts (368 S. State St, Lake Oswego) from 8:30-4:30, May 14-15, 2019. More information can be found at www.foundationsccs.com.

Please submit a registration form and payment no later than May 10, 2019.

Email address *
Participant Name *
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Participant Pronouns *
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Participant Phone *
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Participant Email *
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Participant Address *
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City *
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State *
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Zip *
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Participant Employer *
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Participant Employment Position *
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Where did you hear about this workshop? *
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Do you require any special accommodations?
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I will submit payment in the amount of $200: *
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A copy of your responses will be emailed to the address you provided.
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