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<br /> <br /> <br />Positive Coaching Alliance <br />“Coaching for Winning & Life Lessons Workshop” <br /> <br />Registration Form <br /> <br /> <br /> <br />Please check one, I will be attending the workshop at: <br /> <br />July 31, 2012 (Tuesday) West Hawai`i Civic Center <br />_____ <br /> Registration & Check-in 6:00 pm, Workshop 6:30-8:30 p.m. <br /> <br />August 7, 2012 Tuesday) Aunty Sally Kaleohano’s Luau Hale <br />_____ <br /> Registration & Check-in 6:00 pm, Workshop 6:30-8:30 p.m. <br /> <br />August 28, 2012 (Tuesday) Waimea Community Center <br />_____ <br /> Registration & Check-in 5:30 pm, Workshop 6:00-8:00 p.m. <br /> <br /> <br /> <br />Name: __________________________________________________________ <br />(Please print legibly) <br /> <br />Title: ___________________________________________________________ <br /> <br />Organization (or School): ___________________________________________ <br /> <br />Home Address: ___________________________________________________ <br /> <br /> ___________________________________________________ <br /> <br /> (City) (State) (Zip Code) <br /> <br />Phone: _______________ Cell: ________________ Fax: _______________ <br /> <br />Email ____________________________________________________________ <br /> <br /> <br />Please fax 961-8736 or send completed registration form to: <br /> <br /> P&R <br />Recreation Division <br /> Attn: Darrell Yamamoto <br /> 799 Piilani Street <br /> Hilo, HI 96720 <br /> <br /> <br />POLICY OF NON-DISCRIMINATION ON THE BASIS OF DISABILITY <br /> <br /> <br /> The Department of Parks and Recreation provides recreational opportunities without regard to race, color, national <br />origin, age, sex, religion or disability. Please call Alisa Mitchener, Recreation Specialist, 961-8681 to discuss your <br />need for reasonable accommodation or for more information on site accessibility. <br /> <br /> <br />