(please print out fill in and mail)
Name_____________________________________________
Telephone (H)__________________(W)__________________
Cell ________________ E-mail ________________________
Address____________________________________________
City__________________________State_____Zip__________
Highest Degree Earned_________________________________
Social Security No________________________DOB________
Male______ Female______ Race______
Place of Employment___________________________________
COURSE: check appropriate line
____ EWS 62500 (2 or 3 Hrs.) Self And Student Motivation II (June 4-6)
____
EWS 62600 (3 Hrs.) Self And Student Motivation III (June 6-8)____
EW 50002 (2 or 3 Hrs.) Psychological Survival Skills II (June 11-13)____
EW 50003 (3 Hrs.) Psychological Survival Skills III (June 13-15)