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Name of applicant:
______________________________________________________________________________
Name, dates, and location of workshop to be attended:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date of application:___________________________________________________________
Approval given by Board of Directors (signature of President and date):
_______________________________________________________________________________
Payment made by Treasurer (upon applicant's return from workshop):
_______________________________________________________________________________
Form approved by Board of Directors in June 1999.