Parenting Workshop Registration Form

(March 10, 2017 (begins at 6 pm) - March 12, 2017)

For detailed parenting workshop schedule, please click here.

(Please use only Internet Explorer or Mozilla FireFox (Chrome and Safari browsers doesn't work.)
Please don't use IPAD or Iphone or any hand held device.)

All fields marked with * are mandatory (required) fields!

First Name: * Last Name: *
Home Phone: * Cell Phone:
Street Address: * City: *
State/Province: * Country: *
Zip Code: * email: *
(PLEASE ENTER ONLY ONE EMAIL ADDRESS)
Chinmaya Mission Center Association: *
Special Requests:
Please select a payment Option:
*

Total Cost: $

Please select the appopriate check box: *


Adult only Registration:
$100/person. Adult registration.
Family Registration:

Number of Adults (including you - Include CHYK's as adult as well):
Add Children (4 - 17) :
$150/family. Please select number of Adults and number of children attending from the same family.