Registrant Information
Name:
Address:
City:	State:
Zip:
Phone:
Email:
Yes No	Would you like a certificate for Clock Hours/CEU's - Clock hours will be avilable through the university of St. Thomas, ST. Paul, MN
Please select one of the following	Single $350 Double $300/person Commuter $150 - Single $350 (includes registration, meals & lodging) - Double $300/person (includes registration, meals & lodging) - Commuter $150 (includes registration & meals)
	If paying for Double please list roomates name: