Registration Form
South Region GREAT Center
Please complete a registration form for each person who will be attending workshop(s) from your program. Please print out this form and fax to Mr. Barry Johnson at 361-593-4263 For further information, contact Mr. Johnson at 361-593-2755.
Name: ___________________________________________
Program: _________________________________________
Mailing Address: __________________________________
City:________________ Zip: ____________
Phone Number: _____________ Fax: ________________
Email: _______________________________
Workshop Information
Workshop Topic: __________________________________
Workshop Date(s): ________________________________
Workshop Time(s): ________________________________
Location (City): ___________________________________
For more information, contact Mr. Barry Johnson at the South GREAT Center by email kublj001@tamuk.edu or phone (361) 593-2755.
