SWORTC

Southwest Ohio Regional Training Consortium

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Registration Form

Course Date: *
Course Name *
Agency Name: *
Agency Address: *
City: *
ST *
Zip Code *
Agency Contact Name: *
Day time phone number: *
Contact email: *
Names of Attendees: (Please indicate if attendee needs a Social Worker (SW) or Counselor Certificate (CC) or a Certificate of Attendance (CA) behind the attendee name).
Attendee Name:
Attendee Name:
Attendee Name:
Attendee Name:
Attendee Name:
Attendee Name:
Attendee Name:
Attendee Name:
# of regular box lunches needed:
# of vegetarian box lunches needed:
If you have any special dietary needs, please specify here.
If you have any additional comment or information related to you or you group, please specify here.

After submitting your registration information, please go to the registration payment part of this page and submit your payment for the individuals that you just registered via PayPal. Each registration can handle up to 10 individuals per registration.

Your agency may also pay via check payable to Southwest Ohio Regional Training Consortium and mailed to: SWORTC 10 Burns Ave. Cincinnati, OH 45215

The cost for individual members to attend is $35.00 per class.

The cost for individual non-members to attend is $45.00 per class.