Brains of Trauma REGISTRATION
August 9-10 (6:30-9pm on Friday AND 8am-2pm Saturday)
Douwstra Auditorium
Pella, IA

please complete 1 form for each registering individual
REGISTER EARLY because seating is limited

if you have any questions about the event, please email pycfreetobe@gmail.com

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* 1. What is your FIRST name?

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* 2. What is your LAST name?

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* 3. Contact Information

City/Town

State/Province

ZIP/Postal Code

Email Address

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* 4. What type of CEUs will you want from this event, if available?