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Facilitator Workshop San Diego, CA 01/23/2014

Authorized Facilitator Workshop Registration and Payment
* required information
Please complete the form below. Birth date is a required field for the prerequisite background check. If you are not working with an organization, select Independent as the Facilitator Affiliation.

Your registration will not be complete until you also submit your payment information.

YMCA Affiiliation:
Workshop Date:(mm/dd/yyyy)
First Name:*
Middle Initial:
Last Name:*
Birth Date:*(mm/dd/yyyy)
Preferred Email:*
Organization Name:
Facilitator Affiliation:
Job Title:
Address Line 1:*
Address Line 2:
ZIP/Postal Code:*
How did you hear about us?:
Create Username and Password
Verify password:*
Security Question:*
Security Answer:*


Fees may include a registration late fee.
$402.50 Registration
Location: Big Brothers Big Sisters of San Diego County, 8515 Arjons Dr, Suite A, San Diego, CA 92126

Please proceed to the payment screen to complete your registration.