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*
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Telephone*			Ext.	Website
My agency is a PASE member - Yes No DYCD Funding Source (Click all that apply): 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.

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6/18 -- (OST-GC3) -- Gang Culture: Recognizing, Understanding & Countering

* Agree to PASE Training Policies and Procedures read PASE Training Policies and Procedures
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* Payment
	I do not have to pay because I am a DYCD/OST PROVIDER
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	I agree to make payment by CALLING PASE WITH CREDIT CARD INFORMATION on or before the day(s) of the training
	I agree to make payment by CHECK OR MONEY ORDER made out to Partnership for After School Education, Inc. on or before the day(s) of the training
	I am applying a WORKSHOP CREDIT

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CANCELLATION DEADLINE FOR TRAINING IS 3 DAYS PRIOR TO TRAINING