Dorothy & Associates - Keynotes & Seminars

Upcoming Seminars

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Alabama | Kansas | Michigan | Minnesota | Nebraska

REGISTER ONLINE

Online Registration Form - Step 1
(Use only if paying by credit card or PayPal)

	Registrant's Information: (All fields are required unless noted.)
	Date of Seminar Attending:
	Location of Seminar You will be Attending:
	First Name
	Last Name
	Street Address
	Street Address (Cont.)
	City
	State
	Zip Code
	Address Type	Home Work
	Daytime Telephone
	Evening Telephone
	Your Email Address:
	Occupation:
	Name of Person Submitting Payment:
	*License Number:
	(Required for nurses in Alabama and Kansas)*

For group registrations: Please complete the registration form for the first person. After the form is submitted, you will be given the opportunity to complete additional forms for other registrants.

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