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Reading Day Care


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  $10.00
Fee at the door  $15.00
 
 
Training Title:__________________________________________________
 
 
Training Date:__________________________________________________
 
 
Program Name:_________________________________________________
 
 
Address:______________________________________________________
 
 
City,State,Zip:__________________________________________________
 
 
Phone Number:_________________________________________________
 
 
Email:________________________________________________________
 
 
Do you prefer being notified of trainings being offered by:  ___email or ___mail
 
 
Attendees:_____________________________________________________
 
_____________________________________________________________