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Conference Registration Form(please print, then fill out and mail registration form) I will be attending: Bringing People Together: The Art of Open Adoption Practice Coming Together: The Art of Open Adoption Relationships Both Conferences Name:_______________________________________________________________________ Organization (if applicable): _______________________________________________________ Address: _____________________________________________________________________ City: ___________________________________ State: _________Zip Code:________________ Work #: _______________________________ Home #: _______________________________ E-mail Address: ___________________________________________ Web Address (if any): ______________________________________ Special Diet? Other Needs?: _________________________________ Check here if you would like your personal information omitted from the conference materials. June 21rst Conference only: Please write down the number of the one Intensive Workshop you will be attending. __________ Are you a: (check all that apply. Optional) Family Members: Birthparent Adoptive Parent Foster Parent Adopted Teen or Adult Extended Birthfamily Member Extended Adoptive Family Member Prospective Adoptive Parent Expectant Parent Considering Adoption Adoption Professionals: Private Agency Worker (circle one) Infant/ Older Child Public Agency Worker Adoption Attorney Adoption Facilitator Writer Researcher Adoption Reformer Clinical Services Provider Please make all checks or money orders out to: The Kinship Center. Mail to: The
Kinship Center, 1520 Brookhollow Drive, Ste. 41 |