MPC Registration Form
Print out the form, shown below, and return it with a $25 non-refundable registration fee for each course to:
Patricia Marciniak, M.S.W.
6026 Harkson Drive
East Lansing, Michigan 48823
Please send one form for each course.
There is an additional $25 late registration fee after August 1, 2004
for each Fall course, and December 1, 2004 for each Winter course.
Semester: [ ] Fall [ ] Winter Site:
Phone (Day) (Evening)
Membership Status in MPC [ ] Member [ ] Request for Membership
Training Program Status in MPC [ ] Candidate