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Workshop Application
Space is Limited
Register Early
Part I Workshop Dates____________________ Part II Workshop Dates_____________________
Use ONE registration form for all participants from your agency. Limit THREE attending per agency, per class.
Individual participant preliminary interviews are required. A Circle of Ten professionals will call and schedule a 20-minute
interview. This allows Circle of Ten to tailor the workshop to meet the needs of each individual and agency. All
applications must be submitted to the Workshop Committee for approval.
Date to be mailed:________________
Signature _______________________________
Date________________