WSSB Class Registration Form
Class: CVI Mentor Training - $195 - Housing provided - Aug 7-10 2013
Will you need housing?: YES NO N/A
Name:
Address:
City/State/Zip:
Home and Work Phones:
Email Addresses (Home and Work):
School District:
Your Position:
Will you need materials in Braille or Large Print? Specify here: Braille Large Print NA
Will you be paying by: Check Purchase Order
If Purchase Order, NUMBER:
Make check/purchase orders payable to: WSSB and indicate class title/class date on check Washington State School for the Blind 2214 E. 13th St Vancouver, WA 98661
NOTE: BEFORE you press "Submit" Please print this screen for your records!