Registration Form - Controversial Issues

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Controversial Issues

Tuesday November 19, 2019

Location: Starbridge, Inc., Andrew and Helen Pluta Training Center (Room 118), 1650 South Avenue, Rochester, NY 14620 (fully accessible)

Time: 9 am - 12 noon

Workshop fee is $50, 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/y4lnq62j.

(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 November 15.

Last Name *

First Name *

Email address *

Organization

Address

City, State

Zipcode

Work Phone

Cell or home Phone (please specify)

Comments/Special Requests/Accommodations

Special rate with prior approval (Standard rate is $50)

Group

Student

Senior

Scholarship

Paying by: *

PayPal (standard rate only) (If using someone else's PayPal account, please note this in the "Comments/Special Requests/Accommodations" section above.)

Check payable to "NCBI Rochester, Inc." mailed to Pat Willis at above address

Required

Submit

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