Beyond Medication

Registration ONLY

You will need to bring a check with you to your registered workshop. Please Make check payable to: Julia Grover-Barrey

Workshop Location

Please select the Beyond Medication workshop you will be attending:

Registration Type

Name

First Name

Last Name

Email Address

Quantity

Number of people atending the workshop

Home Telephone

Country

(###)

###

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Cell Phone

Country

(###)

###

####

Work Telephone

Country

(###)

###

####

How did you hear about this workshop?

Do you work directly with children?

Yes

No

If yes, in what capacity?

Name of Employer