Salutation		First Name*		Last Name*
E-mail*				Title*
Job Function*	...select one... Executive Mgnt. Admin. Support Multi-site Director Site Director Program Director Direct Line Staff Volunteer		Organization Name*
Site Name*			<<=== (Enter "NA " if single site organization)
Site Address*				City*
State*				Zip Code*
Telephone*			Ext.	Website
My agency is a PASE member - Yes No DYCD Funding Source* (Click all that apply): My Program DOES NOT HAVE DYCD Funding OST SYEP WIA Beacons Discretionary RHYS CSBG NYCALI BEGIN ISY OSY NDA Literacy Teen Action Immigrant Services As of January 1, 2005, PASE has initiated fees for services, with a discount for Members.

* Please select box to register for this institute
	9/22, 9/25, 9/29, 10/2 -- (NYF–NSD1) -- PASE New Site Directors Institute Click Here to Pay for this Institute Online**** $200 per participant for PASE members and $300 per participant for non-PASE members.

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CANCELLATION DEADLINE IS 3 DAYS PRIOR TO INSTITUTE