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Independent Day Care Providers Network



Registration Form

Please print, fill out, and mail this form along with your check to:
Diane Kariger
IDCPN Coordinator
21 Dana Road
Reading MA  01867

Checks should be made payable to:  I.D.C.P.N.
Pre-registration  $15.00
Fee at the door  $25.00


Workshop Title:_________________________________________________________________

Workshop Date:________________________________________________________________

Program Name:________________________________________________________________

Address:______________________________________________________________________

City,State,Zip:__________________________________________________________________

Phone Number:________________________________________________________________

Email:_________________________________________________________________________


Do you prefer being notified of workshops being offered by: ___email or  ___mail

Attendees:____________________________________________________________________

_____________________________________________________________________________