Thank you for your interest in registering for the Workplace Campaign Coordinator Workshops. Please fill out the following items and note that fields with an asteriks(*) are required.

Please fill out one form for each attendee with their contact information if possible.
If you have any questions or problems with the form please contact Patti Bernor at 813-274-0919 or pbernor@uwtb.org.

* First Name

* Last Name

* Name of Company/Workplace

Location/Store #

* Company/Workplace Address 1

Company/Workplace Address 2

* City

* Zip Code

* E-mail (a copy of the completed form will be emailed to you automatically)

* Work Phone (ex. XXX-XXX-XXXX)

Ext

* Which workshop are you registering for?

Wednesday, June 18 at JP Morgan Chase, Chase Bank Card Services

Thursday, July 17 at Raymond James Financial

Tuesday, August 5 at Tech Data Corporation

Wednesday, September 10 at Children's Board of Hillsborough County

* How long have you been the Campaign Coordinator for your work place?

Comments/Special Instructions

After you hit the SUBMIT button a confirmation email will be sent to the address provided for the attendee.

* Indicates Response Required