Cultural Detective® Registration Form
Workshop Dates:
July 21-22, 2012, Portland, Oregon
Please make a selection.
Name:
Gender:
Male
Female
First name / nickname
for nametag:
Title:
Organization:
Street
:
City:
State/Province:
Zip/Postal Code:
Country:
This address is
Home
Work
Both
Home phone:
Cell phone:
Work phone:
Fax number:
Email
:
In case of emergency, we should contact:
Name:
Relationship:
Address:
Home/Cell phone:
Work phone:
CULTURAL DETECTIVE® FACILITATOR WORKSHOP TUITION
$925 -
Early-bird tuition, requires payment in full by June 22
$995
$300
Optional Credit available through Portland State University (register throught ICI)
How did you hear about Cultural Detective®?
