Multiple Workshop Registration Form

MULTIPLE WORKSHOP REGISTRATION FORM

ATTENDEE INFORMATION

One form per participant please.
Early registration ends two weeks prior to event.
Take $15 off the total fee when registering for three or more workshops at one time (for the same participant).

*required information

Full Name*
Title
Agency*
Address Line 1*
Address Line 2
City*
State/Province*
Postal Code*
Phone (include area code)*
Email*
Workshops* (select all that apply)	Body Image, Weight-related Issues and Eating Concerns among Today’s Youth: Where Are We Now….Where Can We Go?
	Urban Youth: How Can We Engage Them in Healthy Sexuality?
	Providing Culturally and Linguistically Appropriate Services to Latino Youth
	Sex Ed Games that Teach
	A “Special Need” for Sexuality Education
	Sex is a Choice; Love is a Necessity
	E-Teens: Raising Healthy Children and Teens in the Digital Media Age
	LGBT Issues - You've Got Questions, We've Got Answers
Total Owed (take $15 off total if registering for 3 or more workshops)	$
What type of CEUs would you like to request? (Note: We may not be able to offer CEUs for all workshops listed above.)	NASW-TX ($10 extra per person-please add that to your total) TNA (free) NBCC (free) TX St Bd of Social Workers Examiners (free)
Payment Option* (Attendee will be contacted promptly with payment arrangements.)

Once this form is received, a staff member will contact you to confirm and make payment arrangements, if paying before scheduled event.

For more information, call Jennifer Nguyen at (817) 882-1155, ext. 2221 or email her at jennifer.nguyen@ppnt.org.