Registration Form
***Please note that you CANNOT register online for this
conference. If you wish to register
using this form, print it out and mail it in to the conference registrar’s address
at the bottom of this page. Thank you!
Name:_________________________________________________________
Agency:________________________________________________________
Address:_______________________________________________________
City:___________________________________________________________
State:____________________________Zip:__________________________
Phone:____________________________Fax:__________________________
Email:__________________________________________________________
Category (circle one):
|
DHR Placement Staff |
CASA |
|
DHR Resource Development Staff |
Foster Parent |
|
DJJ Staff |
Administrator |
|
Juvenile Court Judge/Attorney/Staff |
Manager/Supervisor |
|
Case Manager |
Other |
|
Private Provider Staff |
|
Please describe any special dietary
needs you might have:___________________
______________________________________________________________
Fees:
Early Bird
Registration….$150
(postmarked
on or before November 1, 2001)
Regular
Registration…..$200
(postmarked
after November 1, 2001)
One-Day
Registration Rates
Wednesday…..$50
Thursday…..$75
Friday…..$50
Please
specify which day you will attend_______________________________
CHECK
NUMBER:_________________________________________________
CANCELLATION POLICY: Request for refunds must be received in
writing no later than October 15, 2001.
A $75 service fee will be charged on all cancellations. Refunds are not processed until after the
conference and will take 6-8 weeks.
Payment Information
Please remit payment with
registration.
Checks and registration forms should
be made payable to GAHSC and mailed to:
2nd Annual Child Placement
Conference
c/o GAHSC
Atlanta, GA 30303
Registration questions please contact:
Child Placement Conference Coordinator
404-572-6170