Docstoc

Marty

Document Sample
Marty Powered By Docstoc
					                  Division of Behavioral Health and Recovery (DBHR)

                                Registration Form
                    Marty Smith Bill-DSHS Safety Training
                             July 13-14th, 2011
                                La Quinta Inn
                                Tacoma, WA
PLEASE WRITE LEGIBLY--THANKS!

Name:_________________________________________________________________

Agency_________________________________Position:_________________________

Address:_______________________________City_________________Zip:__________

Phone:_______________________Email:_____________________________________

Note: A continental breakfast and buffet-style lunch are included both days.

      Please check here if you desire vegetarian meals.

All applicants must check the following box to be registered for training:

      “I understand that if I have any other dietary requirements (gluten-free, vegan,
       food allergies, etc.) I am responsible for making my own arrangements to
       meet my needs.”

Overnight accommodations on 7/13/11 will be provided for attendees whose travel distance
is more than 50 miles on a first-come, first-served basis. Please check below if you will need
a room for 7/13/11 (note: subject to availability):
      YES, I will need overnight accommodations on July 13, 2011.
 Please submit this registration form to: Diane Pearson: pearsond@u.washington.edu or
 Fax to (253) 756-3987. If you have any questions, please call Diane at: (253) 756-2741.

  A registration confirmation will be emailed to you along with directions to the La Quinta
 Inn in Tacoma, WA. NOTE: You are not officially registered for the training until you
              receive this confirmation letter (either by email, fax, or mail).

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:6
posted:4/9/2012
language:English
pages:1