Registration Form for Workshops

*	Indicates required field
*	Name:
*	Address:
*	City, State, Zip:	,
*	Phone:
	Alternate Phone:
*	Email:
*	Member ID Number: (this is the number on the RochesterWorks card received when you registered)
	NY
*	Workshop Name:	(Please review the workshop schedule for Goodman St or Waring Road to enter the correct workshop name)
*	Workshop Location:	(Please indicate either Goodman St. or Waring Rd. Youth Workshops are held only at the Goodman St. location. )
*	Date:
*	Time:
	Accommodation(s) Needed:
	How did you hear about this workshop
		Newspaper Friend Flyer at RochesterWorks RochesterWorks website  Emails from RochesterWorks Other