Division of Behavioral Health and Recovery (DBHR)
Marty Smith Bill-DSHS Safety Training
July 13-14th, 2011
La Quinta Inn
PLEASE WRITE LEGIBLY--THANKS!
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: firstname.lastname@example.org 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).