Heritage Education Commission

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Pre-Registration Form

Pre-Registration: To pre-register for the workshop, including luncheon, return this form with your payment of $40 by September 23, 2012. Make check payable to Heritage Education Commission and mail to: Heritage Education Commission, PO Box 292, Moorhead, MN 56563

First Name

Last Name

Phone Number

E-Mail Address

Address

Address Continued

City State ZIP

Special Dietary Needs?

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