Workshop Series begins in March!

Amethyst Women's Project

Workshop Series Spring 2011 Participant Registration Form

Before registering, please note the following information:

• The workshop series is 10 weeks long, 3 days a week. Although emergencies happen, you will not graduate with a certificate if your attendance is insufficient.
  
• The time commitment is 10:00 AM to 1:00 PM (Monday, Thursday and Friday).
  
• The first session will take place at Amethyst Women's Project in Coney Island,
  
• FREE continental breakfast will be served daily.
  

The Workshop Series begins in March 2011 at 10:00 AM and graduation will be held May.

Please fill out the information below to be registered for our 2011 Workshop Series.

1. Name_________________________

2. Address______________________________________

3. Phone Numbers- Home:_____________ Cell:_______________

4. E-mail (if any) ____________________________________

5. Gender (circle one) male female trans (preferred pronoun ___)

6. Date of Birth: ________________ Age:_______

7. Emergency Contact Name:_____________________ Relationship:________

Phone Number:______________________________

Please note that all information is kept confidential.

E-mail, Mail, Fax, or Drop Off this form to:

Melisa Garber, Peer Coordinator

Amethyst Women's Project

1907 0 Mermaid Avenue

Brooklyn, NY 11224

Phone: 718.333.2067

Fax: 718.996.1756

If you have any questions, please don't hesitate to call or stop by to talk to Melisa.

We can't wait for you to join us!