Name:_________________________________________________

Address:_______________________________________________

            _______________________________________________

E-mail ___________________   [You must have e-mail, with a capacity to receive attachments in Word, and access to the web to participate in the program]

Cell phone______________________                       other phone: _____________________

Parish:_____________________________         Diocese:_____________________________

Position:__________________________

__ Send information on CDI Trainers Certification Programs in Consultation Skills or Leadership

2010- 11 Tuition ...................................................$1650.00

$1000 due with registration  

$300 due on the first day of the program 

$350 due March 1 before your second summer

I am enclosing a deposit of $______________         Checks Payable to "Robert A. Gallagher"

NOTE: Assumption of the program is that every one is registering for the whole program, i.e., both summers.  Deposit refunds  If cancellation is within 8 weeks of the event - no refund; if 10 weeks or more - $200 refund; if 12 weeks or more - $600. Early Registration: Register by December 15 and take $350 off your fee (March 1 payment before your second summer would be $0)

Housing -  You need to arrange for your own housing. See information on the web site

Send to: The Rev. Robert A. Gallagher, 1640 18th Ave; Apt 2 ; Seattle , WA 98122

For more information contact: Robert Gallagher, 206-300-3700