MANSFIELD UNIVERSITY – NON-CREDIT REGISTRATION FORM
SCHOOL VIOLENCE PREVENTION AND INTERVENTION WORKSHOP
Wednesday, April 3, 2013
6:00pm – 8:00pm
Memorial Hall, Room 211
Please arrive early for registration. Class will begin promptly at 6:00pm. Attendance at the entire class is required to ensure certification.
Home Address ______________________________________________________
Home Phone ______________________ e-mail ____________________________
Registration Deadline: March 29, 2013
We regret that no refunds can be given after the registration deadline.
Return this form and check in the amount of $30 (payable to Mansfield University) to 209 Memorial Hall, Mansfield, PA 16933. If unable to return this form by the deadline, please phone 570-662-4974/800-661-3460 or e-mail firstname.lastname@example.org
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