1. Attendee Information  (All fields required)

2. Oahu, Hawaii Registration Selection  (All fields required)

*These discounted group rates are available for 4 or more people from the same agency. Please register all group attendees on the same day; the same organization name is required in the correct field. The discount will be applied prior to processing the payment.

*Lunch on both days is included in the workshop registration fee.

3. Payment Information  (All fields required)

Check payable to: Pacific Agenda
Purchase Order Enclosed
Credit Card Payment (enter details below)
e.g. 03/12
3-digit code on back

Credit Card Billing Address

You will receive email confirmation by mail, along with the credit card receipt if applicable.

You may print this form and mail or fax it to:
Pacific Agenda
McKenzie-Mohr Workshop
PO Box 10142
Portland, OR 97296-0142

Please include check made payable to Pacific Agenda
Fax Number: 503.228.8681

Registration is non-refundable