Working With Latino Clients in Perinatal Care Workshop Registration Form
		Name __________________________________  Position______________________________ Address _____________________________________________________________________ City ________________________________  State ___________  Zip _____________________ Work Phone ( ____ ) __________________  Home Phone ( ____ )  _____________________ E-mail ______________________________  Celular ( ____ )  __________________________     Workshop Title:  Spanish for Childbirth, Puerto Rico, January 13-20, 2008                                    Check one:  ____  $1,250 early (postmarked 6 weeks prior to workshop)                   ____  $1,300 regular                   ____  $1,350 late (postmarked 2 weeks prior to workshop or at the door)
						Method of Payment ____  Check       ____   Money Order      Check #  ________ ____  Visa       ____   Master Card           Credit Card # ________________________ Exp. __________ Signature _________________________________________ Make check payable to:  Cross Cultural Encounters
			A 30-day notice is required for refund.  A $50 administrative fee will be retained.  Cross Cultural Encounters reserves the right to cancel any program due to insufficient enrollment or other unforseen circumstances.  In the event of cancellation by CCE, full refund of registration fees will be given.
	Mail Registrations To: Cross Cultural Encounters, P.O. Box 1665, Lajas, Puerto Rico 00667 Phone Registrations To: (888) 251-4562 (toll free)   Fax Registrations To: (787) 899-7976 Questions: info@crossculturalencounters.com