To pay by mail and check, please print, fill out, and mail this form along with your check to:
Michelle Sousa IDCPN Coordinator
64 Sanborn Street Reading MA 01867
Checks should be made payable to: I.D.C.P.N.
Workshop Title:_________________________________________________________________
Workshop Date:________________________________________________________________
Program/Provider Name:_________________________________________________________
Address:______________________________________________________________________
City,State,Zip:__________________________________________________________________
Phone Number:________________________________________________________________
Email:_________________________________________________________________________
Are you a ___Family Child Care Educator, a ___Preschool/Center based Educator, or a ____Parent?
Do you prefer being notified of workshops being offered by: ___email or ___mail
Attendees:____________________________________________________________________
_____________________________________________________________________________
No refunds will be given except for cancellation of the workshop by IDCPN, or for a change of date of the workshop made within 2 weeks of the workshop by the IDCPN.
Michelle Sousa IDCPN Coordinator
64 Sanborn Street Reading MA 01867
Checks should be made payable to: I.D.C.P.N.
Workshop Title:_________________________________________________________________
Workshop Date:________________________________________________________________
Program/Provider Name:_________________________________________________________
Address:______________________________________________________________________
City,State,Zip:__________________________________________________________________
Phone Number:________________________________________________________________
Email:_________________________________________________________________________
Are you a ___Family Child Care Educator, a ___Preschool/Center based Educator, or a ____Parent?
Do you prefer being notified of workshops being offered by: ___email or ___mail
Attendees:____________________________________________________________________
_____________________________________________________________________________
No refunds will be given except for cancellation of the workshop by IDCPN, or for a change of date of the workshop made within 2 weeks of the workshop by the IDCPN.