CCDRA LOGO Enhanced B307

California Coalition of
Domestic Referral Agencies, Inc.

 

PO Box 84556 ~ San Diego, CA 92138

800-985-3745 ~ info@ccdra.org ~ www.ccdra.org

“2012 Workshop Registration FORM”

Please Print Completing All Information And Return With Your Payment To CCDRA or
Call-in Your Application and Credit Card to 800-985-3745

 

Contact:

Date:

Title:

Name of Agency:

Address:

City:

Zip:

Phone:

eMail:

Fax:

Cell #:

Please reserve 

place/s for me at the workshop.

Workshop Date: 

Enclosed is my check for $

Workshop Location:

.  Make check payable to CCDRA.

Or Call-in Your Application with Credit Card to 800-985-3745.
We accept American Express, Visa, MasterCard or Discover.

If you have questions, call 800-985-3745 or email info@ccdra.org. 
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NB: CCDRA reserves the right to refuse anyone admission to it’s workshops. Each Non-Member attendee must pre-register. Non-Member attendees may be turned away if they have not pre-registered.