Workshop Registration

I would like to register for the "Healing White Racism" 2-day workshop
on Saturday, November 4 & Sunday, November 5, 2006

First Name:
Last Name:
Organization:
Mailing Address:
Address 2:
City:
State:
Zip:
Home Phone:
Work Phone:
Fax:
E-Mail:
How did you
hear about NCBI
or this workshop?
Would you like a certificate of completion?


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