R e g i s t r a t i o n F o r m
Clackamas County
Community Strategy Roundtable
Please fill out registration E-mail, fax, mail in to:
Families Northwest
, PO Box 40584, Bellevue, WA 98015
phone:
503-380-0441 email luke.nelson@familiesnorthwest.org fax: 503-652-6916
Name ______________________________________________________
Position in Agency/Church _____________________________________
Agency/Church ______________________________________________
Address ____________________________________________________
City/St/Zip __________________________________________________
Work Phone ________________________________________________
Web _______________________________________________________
E-mail _____________________________________________________
Fax ________________________________________________________
Credit Card _____________________________ Exp________________
Name as it appears on the card __________________________________
The two sessions will be held at:
New Hope Community Church
11731 Southeast Stevens Road
Portland, OR 97266
May 25th and June 15th
(8:30 am - 12:30 pm)
Cost: $20 covers both sessions.
Registration deadline is Tuesday, May 23
rd - 5 PM
Questions? Contact Luke Nelson: luke.nelson@familiesnorthwest.org
or Portland local 503-380-0441
(
(please answer)
Listed address is:
Work
Home
Payment is:
Business
Personal
Make checks to:
Families Northwest
