WCISEC Workshop Registration

Please fill in all fields and register for each workshop separately!, thank you!

Full Name:

Home Address:

City: State: Zip Code:

Work Address:

City: State: Zip Code:

Phone Number:

Work E-mail Address:

Home E-mail Address:

Name of Workshop:

Date of Workshop: Time of Workshop:

Do you need handicap accomodations? Please explain.

If you don’t receive your confirmation within a week, please give us a call 309-837-3911.

West Central Illinois Special Education Co-op