Training Registration Form

Establishing Child Protection Policies
Pullman Christian Reformed Church
Saturday, May 12, 2012
$15pp (training materials, continental breakfast and lunch included)
Is this your first training with World Vision since September 2010?

____________

Name: ____________________________________________________
Address: __________________________________________________
City: _______________________________

Zip Code: _________________

Preferred Contact Number: _____________________________________________
Fax: __________________________________________________
Email: ________________________________________________________
Church/Organization: ___________________________________________________
Number of youth your organization serves: _______________
List Names of Additional Attendees (if a group):
______________________________________________________________________________
Total Number Attending ________ @ $15
________

Total Amount Enclosed:

(Make Checks or Money Orders Payable to: World Vision)

Please return this completed form along with payment by May 9,
2012 to:
Tondalaya Washington
5001 W Harrison
Chicago, IL 60644
(email) twashing@worldvision.org
(fax) 773-921-3953

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