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Thank you for your interest in attending FCP's Professional Education Workshop on April 5, 2023, featuring Dr. Charles Jacob. Use our secure online portal to register. To pay by check, complete the form and check the appropriate box before submitting your registration. For assistance, contact info@fcpartnership.org or (267) 247-5584.
Registration Information
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Registration Information
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One Time
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Professional Education Workshop
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x $50.00
One Time
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List Additional Registrants Here
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One Time
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For Additional Registrants: List First & Last Name, and E-mail Address
Attendance
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In-Person (at Bucks County Intermediate Unit in Doylestown)
Virtual (via Zoom)
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One Time
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For planning purposes, please carefully consider your selection at the time of registration as we are unable to accommodate last-minute changes.
Primary Registrant Information
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Primary Registrant Information
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Name
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Dr.
Dr. and Mrs.
Miss
Mr.
Mrs.
Mr. and Mrs.
Ms.
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First Name
Last Name
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Job Title
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Organization
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Preferred Mailing Address
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Address Line 1
Address Line 2
City
State
Zip
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Email
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Mobile Phone
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I prefer to pay by check (payable to Foundations Community Partnership). Mail to address below.
Simply check this box to help us cover 3.3% in processing fees.