New APD Provider Workshop Registration
Complete the form below to signup for the workshop. November 30th 2024. Workshop location is 221 Ave O SW, Winter Haven, FL 33880. 10:00am to 1:00pm. No virtual option.
Company
Title
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about the workshop?
APD Group
Friend/Colleague
Online Search
Payment Information: Zelle Payment to 863-399-5822 Please place full name in the notes. $149.00 Your spot is not secure without payment.
Lunch Meal Options
Please Select
Bake Chicken
Salmon
Payment to Complete Registration
Should be Empty: