PRESENTS:

Monday,
April 29, 2008
Centennial AHEC Conference Room
4650 West 20th Street, Greeley, Colorado
(Take 47th Avenue to 20th Street, turn East, go 1/2 block,
Centennial AHEC office on South side of street)
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Audience
Certified
Addition Counselors, mental health professionals, RNs, school nurses, social
service caseworkers, educational paraprofessionals, teachers, and anyone
with an interest in the prevention, diagnosis, and management of FASD.
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Registration
Information
MAKE
CHECK PAYABLE AND MAIL TO:
Centennial AHEC
4650 West 20th Street, Suite A
Greeley, CO 80634
Phone: (970) 330-3608 FAX: (970) 330-3698
(Please Print Legibly)
Name ______________________________________________________________________________
Discipline or Title _____________________________________________________________________
Home Address _______________________________________________________________________
City _____________________________________________________ State ____ Zip ______________
Employer ___________________________________________________________________________
Employer City _______________________________________________________________________
Business Phone ______________________________ Home Phone ______________________________
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FETAL ALCOHOL SPECTRUM DISORDER Registration
postmarked by April 18 -- $20.00 |
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Please charge to my: ___VISA ___MasterCard ___Discover
Card # ______________________________________________________________________________________
Signature ____________________________________________________________________________________
Expiration
Date ________________________________________________________________________________
Registrations
may be faxed with a credit card # to (970) 330-3698.
PURCHASE
ORDERS:
If purchase orders are used, send this completed registration form with
a copy of the purchase order on company letterhead. Payment must be received
by the start of the seminar, or a personal check/cash/credit card will be
necessary to attend. No one will be permitted to attend without prior payment
per CAHEC policy.
REGISTRATION
CONFIRMATIONS:
You will receive confirmation by mail. If you do not receive a letter two
days prior to the seminar, please contact the CAHEC office at 970-330-3608.
REFUND
POLICY:
Fee refunded less a $25.00 handling charge if canceled by the early registration
deadline.
No refund after early registration deadline.
CAHEC reserves the right to cancel a seminar due to insufficient enrollment
or unforeseen circumstances. All registered persons will be notified if cancellation
becomes necessary.
SPECIAL
ACCOMMODATIONS:
If you require an interpreter or other special services, please contact the
Centennial AHEC office two weeks prior to the seminar.
YOU
MAY ALSO REGISTER VIA THE WEB BY
Downloading
an MSWord Registration form
and
emailing or FAXing it to us
OR
BY
Downloading
an
Adobe Acrobat PDF Registration form
and
FAXing it to us
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of
part of the
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These activities are part of a statewide effort and are partially funded through state appropriations to UCHSC.
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