REGISTRATION —
Playground Supervision Training for Elementary Schools

Please choose the session you would like in which you would like to enroll.

	Mr. Mrs. Ms.
First Name:
Middle Initial:	(Required, your middle initial is used in your username.)
Last Name:
Home Address:

City:
State:		Zip:
Home Phone:		Fax:
E-mail:

CEU
	Yes, I'd like CEU credit (There is an additional $10 processing fee to receive a CEU)

Payment ...... $15 Prepayment is required. You can pay by:
	Credit card (please call to give credit card information)
	Purchase Order (please mail or fax)
	Check (please mail)
	Toll free number: 800-554-PLAY (7529) Fax: 319-273-7308 Mail: NPPS University of Northern Iowa Human Performance Center 103 Cedar Falls, IA 50614-0618

The Leader in Research, Training, and Development of Safe Play Areas.