Workshop Registration

Please fill out the following information in order to register for workshops with The Childcare Network. (Payment, if required, can be made after you have submitted this form. Your registration will not be processed until your payment has been received.)

Name:
Name of child care program, center, or home
(leave blank if none):
Address:
City:
State:
Zip Code:
E-Mail Address:
Phone:
2nd Phone:
Date of birth:
Last 5 digits of SSN:

Please check the workshop(s) that you are registering for:


The Business of Family Child Care
Monday November 2, 7-8:30 pm
Free of charge
The Business of Family Child Care
Wednesday January 6, 2010, 7-8:30 pm
Free of charge