Last Name ___________________________________________________
Title ☐Dr. ☐Prof ☐Ms. ☐Mrs. ☐Mr. Last Name ___________________________________________________ First Name & MI __________________________________________ Affiliation: _______________________________________________________________________________________________________________________ Address: _________________________________________________________________________________________________________________________ Street City State Zip Code Phone #: ____________________________________________________ Alt. Phone #: ______________________________________________ Email: _______________________________________________________ Website Address: _________________________________________ REGISTRATION FEE: $75.00 PAYMENT ☐My Check made payable to the University of the Virgin Islands is enclosed. …
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Title ☐Dr. ☐Prof ☐Ms. ☐Mrs. ☐Mr. Last Name ___________________________________________________ First Name & MI __________________________________________ Affiliation: _______________________________________________________________________________________________________________________ Address: _________________________________________________________________________________________________________________________ Street City State Zip Code Phone #: ____________________________________________________ Alt. Phone #: ______________________________________________ Email: _______________________________________________________ Website Address: _________________________________________ REGISTRATION FEE: $75.00 PAYMENT ☐My Check made payable to the University of the Virgin Islands is enclosed. ☐CREDIT CARD: ☐Visa ☐Master Card ☐AMEX Name (as it appears on your credit card) __________________________________________________________________________ Address (if different from above) __________________________________________________________________________________ Credit Card #: ________________________________________________________ Expiration Date: _____________________ Signature: ____________________________________________________________ Date: _________________________________ Please print and complete this form and fax, mail or email to the address below. ~~~ University of the Virgin Islands Center for the Study of Spirituality and Professionalism (CSAP) Office of the President #2 John Brewers Bay ~ St. Thomas, V.I. 00802 (340) 693-1240 (O) / (340) 693-1005 (F) Email: csap@live.uvi.edu / wendy.coram@live.uvi.edu www.uvi.edu Please indicate if you need Contact Hours for Continuing Education Credits by checking the box. ☐ ☐St. Thomas Campus ☐St. Croix Campus UVI Center for the Study of Spirituality and Professionalism (CSAP) ETHICS WORKSHOP REGISTRATION FORM “BUILDING A CULTURE OF ETHICS: DIMENSIONS AND STRATEGIES”