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.
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:________
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
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!