Registration
Civics Education Workshop
Participant Information
First Name:
Middle Name:
Last Name:
(primary contact is made VIA email, please check your mail often for important information regarding the workshop)
Primary Telephone Number:
Email address
Verify Email address
Address:
Address (Line 1):
Address (Line 2):
City:
State:
Zip Code:
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Additional Information:
CCP Student
Alumni
Other
How did you hear about the workshop?
Important: Registration is not complete until the $50.00 payment is processed.