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REGISTRATION FORM 2024

First Attendee*

All Community Leadership Titles Select One*

REGISTRATION FORM -"Nurture Yourself For Better Mental Health" Name - (Last, First, M.I.)

Name of your Church/Organization/Agency

Address 1 - (Street, Suite/Apt.#)

Address 2 - (City, State, Zip)

Cell Phone Number*

E-mail Address*

Executive Assistant Name

Telephone Number

Registration Fee*

Number of Attendees*

Check Mailed*

CLICK HERE to make a payment to DC Alliance Empowering Homicide Survivors, Inc.

CLINICAL EDUCATIONAL TRAINING

Please add quantity based on the number of attendees that were selected above.

Clinical Training Workshop

$25.00Price

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