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					                                                                                                         Page 1

June 2005

Dear Region 1 DD Training Co-op Member:

Welcome!
The Training Advisory and Steering Committee (TASC), the managing and oversight group of
the Region I DD Training Co-op) is happy that you have decided to join and/or continue in this
new adventure. With 33 voluntary Co-op members we have been able to put together what we
think is a fabulous training schedule for 2005.

Enclosed is your "Host Kit". This has been provided to help you organize your hosting process
and streamline forms to make your experience in hosting a community-wide training enjoyable.

"Host Kit" includes:

-   Annual Plan/Master Schedule                    -   List of Training Sites
-   List of Mentors for each Host Agency           -   Flyer Template
-   Financial Risk of Hosting Co-op Class          -   Registration Template
-   Suggestions for OIS Co-op Hosts                -   Class Roster Form
-   List of TASC Members                           -   Completion Report Form
-   List of Co-op Members                          -   Evaluation Form
-   List of Instructors & Courses                  -   Certificate Template

General Information:

- If you know of other agencies who are interested in becoming a Co-op member, please have
  them contact their County's TASC representative (see list of TASC members) for a Co-Op
   application and more information. TASC representatives will contact them when enrollment
  re-opens.

- For 2005, like 2004, Co-op members are assigned 1 to 3 classes per year that they are to
  host. If you have questions please call your assigned mentor friom the list in this kit.

- Please do NOT make changes to the Annual Plan/Master Schedule yourself. Call the Host
  Kit Keeper and your Mentor if you are unable to have your class in the target month.
     You must plan a new date or target month and follow through!
     If you need to make a full trade, please follow instructions below.
- Please allow TASC committee members to attend classes free of charge to monitor quality
  of classes and to help answer any questions about the Region 1 DD Training Co-op.

- The website will be periodically updated. Please check it often for the most current
  class information and course descriptions available!

- This Annual Plan/Master Schedule runs January to December.




                                                                                                 Rev. 7/21/2010
                                                                                                            Page 2

How Do I Trade Classes:

- Seek out a straight across trade agreement with another Co-op member.

- E-mail change to every Co-op member.

- Telephone the Host Kit Keeper to make sure they update the Master Schedule.
 Make sure you talk to the Host Kit Keeper DIRECTLY .


Co-op Member Agency Responsibility:
- Assign a Contact person to receive and distribute Co-op Class flyers among your agency's
"circle". This person will take the lead for seting up, sending publications to E-mail Keeper,
and hosting the 1-3 classes (usually 1-2) assigned on the Co-op Annual Plan/Master Schedule.
Monthly Contact Person's Flyer Distribution Responsibility

- Send out all monthly flyers sent from E-mail Keeper from other host agencies to your "circle"
 such as, your staff, individuals and families, and individual subcontractors as soon as you can.
Counties will send flyers to Foster Care Providers.

What Do I Do When It is My Turn to Host a Class?

Three (or four) months prior to your assigned class:

- Review "Host Kit" sent to you by the Host Kit Keeper. Every time you receive a "Host Kit"
   from the Host Kit Keeper you should replace the previous one with it. If you want it earlier,
  contact the Host Kit Keeper or your TASC Mentor contact, who should be able to send it to
 you by email in Excel or other available format.

THREE months prior to an assigned class:

- Monitor/track all hours spent coordinating and hosting your class.

- Check the Annual Plan to see who else is hosting a class in your same month.
   Coordinate with those other Co-op member contacts planning classes to ensure that
  your classes are scheduled on different days.

- Secure instructor/training site, date, time and equipment needed. Pay any related costs.
  Determine your registration fee per person (see fee worksheet tab below) and form of
 payments that are acceptable. Set up a process and person in your agency to process
 registrations. E-mail flyer and registration form to E-mail Keeper for distribution to all
 co-op member contacts by the MIDDLE OF THE MONTH TWO MONTHS PRIOR to the
 DATE of the CLASS (For Example: for a June Class, flyers should be out to the E-mail
 Keeper by April 15th) and begin to take registration fees (i.e. $10.00 & up). All fees must
 be paid in advance for one to be considered registered. Fees for non-Co-op members are
double those for Co-op members. Non-members are generally staff of agencies who opted
 not to join the Co-Op. Families of consumers are always allowed in at member rates.

- Website contact (SDRI for 2005) is a member of the Co-Op so when receiving the flyer will
  know to update website with your current class information (class title, instructor, date, time
                                                                                                    Rev. 7/21/2010
                                                                                                          Page 3

 location/address, fee per person, contact person for registration, and contact person for
 questions if different.

- After a week, double check that the Website person has updated your class with the correct
  information. If corrections are needed, contact website person promptly.

- Send out flyers to your staff and individual subcontractors.

- Tally all hours spent coordinating and hosting class.

Week prior to class:

- Set aside at least 50% of the capacity for Co-op members. Any space remaining a week
  prior may all be used for host's staff or individual subcontractors.

- If registration is less than 10 or other minimum number set by instructor, the class may be
  cancelled. Co-op hosting responsibility will be considered met. Registrants, E-mail Keeper,
  Host Kit and Website Keeper must be notified ASAP.

- Reconfirm logistics with instructor and training site coordinator.

Day of class:

- Prepare room/restrooms, equipment, simple snack and beverage (coffee, tea, cookies,
  crackers, muffins, fruit, etc.), sign-in roster with pre-registrants names, evaluations, and
 Certificate of Completion for each registrant.

- If you are accepting walk-ins, be prepared to accept registration fees.

- Make copies of instructor's handouts to give to registrants (Please also send copies of
  to Paper Keeper with your completion packet).

- Introduce the instructor and explain any logistics to the registrants.

- Collect your evaluations and hand out Certificates.

Two weeks after class:

- Submit one copy of class handouts, all evaluations, the completion reports and the final
  Roster to the Paper Keeper.

- To update any changes or additional information (i.e. training site, course, instructor list,
  etc.) for Host Kit please contact the Host Kit Keeper.

- If you have a request for replacement of a lost certificate direct them to the Paper
  Keeper and inform them of a charge of $5 per certificate replacement. Keeper can only
  replace certificates for those she has received rosters. Payments go to the Paper
  Keeper's agency. The Paper Keeper will send certificate to registrant upon receiving
  payment and confirming attendance.

Centralized Website and link:

                                                                                                  Rev. 7/21/2010
                                                                                                  Page 4

http://sdri-pdx.org/training/co-op
Follow the Region 1 DD Training Co-op link

Key Contacts for 2005:
Please free to call upon your mentor or any TASC members for more information.

Host Kit Keeper:                                             Website Keeper:
Robyn Hoffman, Clackamas County                              Michael Gmirkin, SDRI
robynhof@co.clackamas.or.us                                  michael@sdri-pdx.org
503-557-2872                                                 503-292-7142

E-mail Keeper:                                               Paper Keeper:
Robin Wiggin, Region I Crisis Diversion Office               May Nelson, Inclusion Inc.
robin.g.wiggin@co.multnomah.or.us                            3454 SE Powell Blvd.
503-988-3703 xt. 222                                         Portland, OR 97202
                                                             503-232-2289 xt. 12




                                                                                          Rev. 7/21/2010
                                           REGION 1 D.D. TRAINING CO-OP
                                                    MASTER SCHEDULE 2005

P = Postponed        FINAL VERSION by Hoffman & Wiggin (after TASC input & corrections to 12/8/04)
C = Cancelled       IMPORTANT: Assigned classes MUST be set up & publicized MINIMUM 2-3 months ahead!

M
            HOST AGENCY                      E-MAIL                       CLASS TOPIC                      INSTRUCTOR
O


        Clackamas County DD                                                                  Jessica Leitner
                                   robynhof@co.clackamas.or.us A User's Guide to the DD System
J
A
        Columbia County DD         corissan@ccmh1.com              Fetal Alcohol Syndrome         Diane Maldin
N
U
    P Adult Learning System        jcrawford@alsoweb.org           Psychotropic Drugs             James Clay, PsyD or TBD
A
R
                    Albertina carold@albertinakerr.org
        Abertina Kerr Centers Kerr Centers carold@albertinakerr.org
                                                       OIS - General                        OIS - General
                                                                                                   Carol Dinsmore, Mentor Trnr
Y




F
E   P Riverside Training Centerindy.stockton@riversidecenters.com to DD
                              c                             Intro                                 Wiggin/Carder/Bahnson
B
R       Region 1 Crisis Diversion                             Understanding Behavior
                                 robin.g.wiggin@co.multnomah.or.us                                Mike Larson/Dave Langlois
U
A       Community Access Svcs.A.Baksay@verizon.net                  Fatal Four                    Comm. Access RN's
R
Y   P   DSI Brokerage                                          Find,
                                   amy.zulich@thementornetwork.com Hire & Keep Employees          TBD (DSI choice)
                                   artprogram@portcitydevelopment.org
        Port City Development                                      Teambuilding                   Regina Kalandros-Simmons



        Eastco Diversified Services
                                 snorman4@verizon.net              Personality Disorders          James Clay, PsyD
M
        Community Access Svcs.arlene@CAS-DD.org                    OIS-General Level              Susan Snyder? (If Mentor Trnr)
A
R
        SERP Enterprises           judy@serpenterprises.com                                      Agency
                                                                   Recreation Options for People with DD Trainer or TBD
C
H
        Mt Angel Training Centerrckne3@aol.com                     Autism 1                       Mike Larson
        Integrated Services Netwk
                               cshuler@seasurf.net                 Fatal Four (in Clatsop Co)     State RN - Clatsop

        Rainbow Adult Living                                        Medical Record Keeping
                                   pjkerns@msn.com & rainbowadultliving@msn.com                   Mike Malchow-Hay



        Good Shepherd Comm. dboylan@gscommunities.org                                           George Hall, LCSW
                                                                   Attachment Disorders & Brain Function
A
P
        Arc Multnomah              vsmead@thearcmult.org           Brainstorms & Seizures         Jill Foreman, Epilepsy Assoc.
R
I
        Community Services Inc cbaron@cs-inc.org                   Prader Willi Syndrome          Rik Mayfield, CSI 648-6415
L

                                                            "Welcome to My World"
        Washington County DD jerri_rudacil@co.washington.or.us                                    Lori LeDuc

        Clatsop County DD          Dspath@co.clatsop.or.us                                    Robin Wiggin
                                                                   Money Management (for People in DD Services)


        Tualatin Valley Workshop
                               dpierce@tv-workshop.com             Fatal Four                     State RN's

        Port City Development                                                                 George Hall
                                   info@portcitydevelopment.com Positive Prgm - Sexually Aggressive Behavior
M
A
        Multnomah County DD                                    OIS
                                   marti.a.good@co.multnomah.or.us - General                      Mentor Trainer TBD
Y

        SERP Enterprises           judy@serpenterprises.com        Intro to DD                    Wiggin/Carder/Bahnson

        Coast Rehab - Clatsop      vickio@coastrehab.org           Behavior 2                     Julie Snook

        Mt Angel Training Centerrckne3@aol.com                     Autism 2                        M Larson /Jane Rake



        Goodwill Industries        bmartin@gicw.org                Down Syndrome & Aging          Lori Thompson
J
U                                snorman4@eastcodiversifiedservices.com with Survivors of Abuse
        Eastco Diversified Services                           Working                        Mike Larson
N
E
        Page 5                                                                                                  Rev. 7/21/2010
                                       REGION 1 D.D. TRAINING CO-OP
                                               MASTER SCHEDULE 2005

P = Postponed     FINAL VERSION by Hoffman & Wiggin (after TASC input & corrections to 12/8/04)
C = Cancelled     IMPORTANT: Assigned classes MUST be set up & publicized MINIMUM 2-3 months ahead!

M
         HOST AGENCY                    E-MAIL                        CLASS TOPIC                     INSTRUCTOR
O
J
U
N
E     Community Access Svcs.kathy@cas-dd.org                  Bloodborne Pathogens          Kathy Haines, RN

      Rainbow Adult Living     pjkerns@msn.com                Sign Language I               Miriam Berman



J     Inclusion Inc.           may@inclusioninc.org          OIS-General Level              TBD Mentor Trnr
U
L                                                         Diabetes Management
      Washington County DD jerri_rudacil@co.washington.or.us                                Helen Emmons, RN
Y
      Community Vision         jhoofard@hotmail.com          Autism 1                       Mike Larson



A U   CCI Enterprises (voc)                                  Rights of Individuals w/Dis.
                               bstuva@ccienterprises.org & kenf@ccienterprises.org          Kori Brooks or TBD
 G
U S   Westside Comm'ty Focusmistev82@comcast.net             Bloodborne Pathogens           TBD/Agency Staff
 T
      Arc Multnomah            Vsmead@thearcmult.org         Special Needs Trust Planning Mitch Teal, Arc of Oregon


S
E     Albertina Kerr Centers                                  OIS-General
                               daniellem@albertinakerr.org & carold@albertinakerr.org       Carol Dinsmore, Mentor Trnr
P
T
      Community Services, Inc.
                             cbaron@cs-inc.org               Intro to DD                    Wiggin/Bahnson
E
M
B     Adult Learning System                                 Autism 2
                               jcrawford@alsoweb.org & bturner@alsoweb.org                  Mike Larson / J Rake
E
R     OESCO                    maryellenb@oescorp.org        Behavior 2                     Julie Snook



      DSI                                                  Behavior
                               meredith.wexler@thementornetwork.com 3                       Julie Snook
O
C     Senior Center Project    jdoyle@ci.portland.or.us      Fatal Four                     State RN
T
O
B
      Riverside Training Centers                            Personality Disorders
                              cindy.stockton@riversidecenters.com                           James Clay, Psy D (ORA)
E
R                               Office                      Understanding Behavior
      Region I Crisis Diversionrobin.g.wiggin@co.multnomah.or.us                            Mike Larson & Dave Langlois




N
O
      Columbia County DD                                     IEP & Transition Issues
                               corissan@ccmh1.com & lynnan@ccmh1.com                        OrPTI instructor or TBD
V
E     Coast Rehab - Multnomahmybonnie@comcast.net
                            A                                                              M Larson
                                                              Attachment Disorder & Brain Function or Geo. Hall
M
B     Clackamas County DD      robynhof@co.clackamas.or.us    OIS - General                 Mentor Trainer
E
R
      Port City Development                                  Mandatory Abuse Reporting artprogram@portcitydevelopment.org
                                                                                                 Nyla
                               info@portcitydevelopment.org & carlos@portcitydevelopment.org & & PSI's McCarthy or Tom Zaner



D
E
      Portland Metro Res. Svcs.                                                     Robin Wiggin
                                                        Money Management (for Individuals in DD Services)
                              KappyNelson@msn.com & MeiLouie@msn.com
C
E     Up & Out, Inc.                                         Sign
                               upandout@peak.org & mytwtee@aol.com Language                 Miriam Berman or TBD
M
B
E
R




      Page 6                                                                                              Rev. 7/21/2010
TASC MENTORSHIP LIST (M's advise of hosting & other Co-Op activities)
         Host Agency             Mentor         Phone          Mentor Agency
Adult Learning Systems       Susan Norman    503-667-0613    Eastco
Albertina Kerr               Robyn Hoffman   503-557-2872    Clackamas Cnty DD
Arc of Multnomah             Vicki Smead     503-223-7279    Arc of Multnomah
CCI Enterprises              Robyn Hoffman   503-557-2872    Clackamas Cnty DD
Clackamas County DD          Robyn Hoffman   503-557-2872    Clackamas Cnty DD
Clatsop County DD            Corissa Neufeldt 503-397-5211   Columbia Cnty DD
Columbia County DD           Corissa Neufeldt 503-397-5211   Columbia Cnty DD
Community Access Svc.        Jerri Rudacil   503-846-5743    Washington Cnty DD
CSI                          Robin Wiggin    503-988-3703    Region 1 Crisis Div.
Community Vision             Wendy Taliaferro 503-292-7142   SDRI
Coast Rehab - Clatsop        Susan Norman    503-667-0613    Eastco
Coast Rehab - Mult.          Susan Norman    503-667-0613    Eastco
DSI                          May Nelson      503-232-2289    Inclusion, Inc.
Eastco                       Susan Norman    503-667-0613    Eastco
Good Shepherd                Jerri Rudacil   503-846-5743    Washington Cnty DD
Goodwill                     May Nelson      503-232-2289    Inclusion, Inc.
Inclusion, Inc.              May Nelson      503-232-2289    Inclusion, Inc.
Integrated Services Netwk    May Nelson      503-232-2289    Inclusion, Inc.
Mt Angel Training Center     Robyn Hoffman   503-557-2872    Clackamas Cnty DD
Multnomah Cnty DD            Robyn Hoffman   503-557-2872    Clackamas Cnty DD
OESCO                        Wendy Taliaferro 503-292-7142   SDRI
Port City Development        Robin Wiggin    503-988-3703    Region I Crisis Div.
Portland Metro Res. Svcs.    Susan Norman    503-533-4373    Community Access
Rainbow Adult Living         Robin Wiggin    503-988-3703    Region 1 Crisis Div.
Region 1 Crisis Diversion    Robin Wiggin    503-988-3703    Region 1 Crisis Div.
Riverside Training Centers   Corissa Neufeldt 503-397-5211   Columbia Cnty DD
SDRI                         Wendy Taliaferro 503-292-7142   SDRI
Senior Center Project        May Nelson      503-232-2289    Inclusion, Inc.
SERP                         Corissa Neufeldt 503-397-5211   Columbia Cnty Dd
Tualatin Valley Workshops    Jeri Rudacil    503-846-5743    Washington Cnty DD
Up and Out                   Jeri Rudacil    503-846-5743    Washington Cnty DD
Washington Cnty DD           Jeri Rudacil    503-846-5743    Washington Cnty DD
Westside Community Focus Jeri Rudacil        503-846-5743    Washington Cnty DD
           FINANCIAL RISK AND HOSTING REGIONAL CO-OP CLASSES
If you have been selected to host a class that requires using a trainer with a fee, there are a few
things to keep in mind. First and foremost, no co-op member should accept sustaintial financial loss
as a result of being a member of the co-op. Second, ther are ways to aviod taking a financial hit for
hosting a class.
              1. When you are negotiating a rate/contract with the trainer make sure to ask these
            questions in addition to all the other logistical questions:
                    * What is the maximum number of students you will allow in the class?
                        Are there printed materials? Do you provide them? Is that cost included in
                    * the training?
                    * Will you sign a contract/commit to this training thatwill allow for a 1 week
                    * cancellation notice if we are unable to get enough registrants?
             2. Calculate the total cost to your agency based on the following:
                    Instructor fee fee
                            Instructor
                    Printing costscosts of materials/handoutsflyers
                            Printing of materials/handouts & & flyers
                    Snacks/beverages -- if you are providing
                            Snacks/beverages--if you are providing
                    Room reservation fee -- if you are nsing using a space
                            Room reservation fee--if you are not a free free space
                      Number of your staff attending (how much would you be paying to send them
                    elsewhere to of your staff same or similarmuch would you be paying to send them elsewhere to
                          Number receive the attending (how training)
                      Number of registrants/attendees that trainer and /or space will allow

            3. After you have considered all of the above cost factors, you should be ready to
           calculate the registration fee that you will charge participants. When you are figuring the
           costs per person, it is safe to assume you may fall short a few registrants. Set the
           minimum number of registrants you need to be comfortable with your agencies costs.


             4. Advertise your class with roughly a one month advance. If within 2 weeks of the
           class you are not near your minimum number of registrants, contact someone on the
           TASC. The TASC will assist in trying to fill your class. If within 1 week of the class you do
           not have enough registrants to recoup enough of your costs, cancel the class.
              5. See the attached example of figuring out costs and registration fee.
Class: Training for People Doing Trainings
Instructor: Joe Trainer

Description                     Cost per unit/person             total cost
Instructor Fee                    $300.00                                $300.00
room reservation                     $0.00                                  $0.00
materials                            $2.00                               $100.00
snacks                               $2.00                               $100.00
other
                                              total cost
                                              to agency:                $500.00


maximum number of students               50
# of students from our agency             3
total # of paying students               32

cost per student from outside agency                   $15.00
cost per student if 10% below registration             $17.36

registration fee                              $15/student
minimum acceptable outside registrants                      22
                                    SUGGESTIONS FOR OIS CO-OP HOSTS

Hosting the OIS training does involve some possibility of financial rist for co-op members. The below
suggestions are to help minimize risk for your organization.
    It is critical to understand that there are only select OIS trainers who have appropriate certification to do
    OIS training outside of their own agency. There are a number of trainers locally who have this statewide
  1 training certification. These trainers are:

    John Mushlitz      503-317-5880                            $600   Will use co-trainer/manuals negotiated
    Julie Beaton       503*481-5172                            $600   Will use co-trainer/manuals negotiated
    Mike Larson        503-988-3703-X231                       $600   Will use co-trainer/manuals negotiated
    OTAC               503-364-9943 x23                        $600   Contact Kelley Gorham--has 4 trainers available + co-trainers


    If trainers use a co-trainer they can increase the number of class participants to 22. Ask the trainers about
    this possibility because it will decrease the cost per student and, hopefully, help insure enough participants
    to cover the cost of the trainer. Having 22 participants should lower the registration cost to $40 or below.
  2 If your cost is more than $40 you may not get enouh attendees.
    Negotiate with trainer how manuals are provided. Some may charge extra for the supplying manuals.
    Printing costs can be as high as $5-6/each. Even if you print the manuals your cost would be roughtly
    $33.28 per person if you have 22 enrollees. If you negotiate that the manuals are covered by trainer, then
  3 your cost per person is $27.28 with a full class.
    Don’t forget that you should provide some beverage and light snack -- add a few dollars per person for this
  4 cost. Once you have figured your approximate costs, set your registration fee.
    The room also needs to be reserved for 2 full days, accommodate up to 24 people and have space for both
  5 the brain work and the physical practice portions of the training.
    You need to decide when you are setting your registration fee amount whether you are willing to accept
    any financial loss and set a minimum number of attendees based on your decision. OIS usually fills up
    quickly so you should not have a problem filling a class if it is well advertised to co-op members. However,
    in the event you do not gwet the minimum mumber of attendees you need contact the TASC and ask for
    hepl filling sports. If you still do not get enough registrants, cancel the class. No co-op member should
  6 have to absorb large financial losses as a result of being a member.
                                              Region I - DD Training Co-Op
                                                        T.A.S.C.

           NAME                   AGENCY                      PHONE #                              E-MAIL                            ADDRESS
    Robin Wiggin                                        503-988-3703 xt 222 robin.g.wiggin@co.multnomah.or.us           4850 SW Scholls Ferry Rd., #104
                       Region I Crisis Diversion Ofc.
    E-mail Keeper                                                                                                       Portland, OR 97225
    Robyn Hoffman                                       503-557-2872           RobynHof@co.clackamas.or.us              524 Main St.
                       Clackamas County DD
    Host Kit Keeper                                     503-723-4933 Fax                                                Oregon City, OR 97045
    May Nelson                                          503-232-2289 xt 12     may@inclusioninc.org                     3454 SE Powell Blvd.
                       Inclusion, Inc.
    Paper Keeper                                        503-235-6914   Fax                                              Portland, OR 97202
    Wendy Taliaferro                                 503-292-7142              wendy@sdri-pdx.org                       1730 SW Skyline Blvd., Ste. 127
                       SDRI - Self Determination Resources Inc.
    Michael Gmirkin                                                            michael@sdri-pdx.org                     Portland, OR 97221
    Website Keeper
    Jerri Rudacil                                       503-846-5743           jerri_rudacil@co.washington.or.us        3700 SW Murray Blvd., Ste. 300
                  Washington County DD
                                                                                                                        Beaverton, OR 97006
    Corissa Neufeldt                                    503-397-5211 xt 204 CorissaN@ccmh1.com                          105 S 3rd St.
                       Columbia County DD
    Lynn Nolting                                        503-397-5373   Fax     Lynnan@ccmh1.com                         St. Helens, OR 97051
    Trish White                                                                twhite@co.clatsop.or.us                  800 Exchange, Suite 300
                       Clatsop County DD
                                                                                                                        Astoria, OR 97103
    Susan Norman                                        503-667-0613           snorman4@eastcodiversifiedservices.com   PO Box 470
                       Eastco Diversified Services
                                                                                                                        Gresham, OR 97030
    Meridith Wexler                                                   meridith.wexler@thementornetwork.com
                                                    503-258-2440 xt 135                                                 305 NE 102nd, Suite 100
                       DSI - Developmental Systems Inc.
                                                                                                                        Portland, OR 97220
    Arlene Baksay                                       503-533-4373           arlene@CAS-DD.org                        2123 NW Aloclek Dr., Ste. 1203
                       Community Access Services
                                                                                                                        Hillsboro, OR 97123
    Vicki Smead                                         503-223-7279 xt 611 vsmead@thearcmult.org                       619 SW 11th, #234
                       The Arc of Multnomah
                                                                                                                        Portland, OR 97205
    Elaine Petersen                                     503-988-3658 x 26361 elaine.a.petersen@co.multnomah.or.us       421 SW 6th, Ste. 400
                       Multnomah County DD
    (inactive)                                                                                                          Portland, OR 97204-1621



Revised 7/21/2010                                                                                                                                 Page 11
                             Region I - DD Training Co-Op
                                       T.A.S.C.

           NAME     AGENCY         PHONE #         E-MAIL   ADDRESS




Revised 7/21/2010                                                     Page 12
                                                                        Region 1
                                                                DD Training Co-Op
           UPDATED 6/15/05 Robyn Hoffman
                MEMBER            CONTACT
                                                                    Members
                                                                 PHONE # EXT                              E-MAIL                           ADDRESS
       1 Adult Learning System        Julie Crawford             503-254-1622              jcrawford@alsoweb.org                4110 NE 122nd, Ste. 150
         of Oregon, Inc.              Bob Turner                                           bturner@alsoweb.org                  Portland, OR 97230
       2 Albertina Kerr Center        Carol Dinsmore             503-262-0158              carold@albertinakerr.org             722 NE 162nd Ave.
                                      Danielle Mathes             503-408-5038      Fax    daniellem@albertinakerr.org (tent)   Portland, OR 97230
       3 Arc of Multnomah, The        Vicki Smead                503-223-7279              vsmead@thearcmult.org                619 SW 11th, #234
                                                                                                                                Portland, OR 97205
       4 C.C.I. Enterprises           Ken Fosheim                503-652-9036              kenf@ccienterprises.org              5285 SE Mallard Way
                                      Bob Stuva                  503-652-9036              bstuva@ccienterprises.org            Milwaukie, OR 97222
       5 Clackamas County DD          Robyn Hoffman              503-557-2872              robynhof@co.clackamas.or.us          524 Main St
                                      Adrienne Miller            503-723-4933              adriennemil@co.clackamas.or.us       Oregon City, OR 97045
       6 Clatsop County DD            Trish White                503-338-3600              twhite@co.clatsop.or.us              800 Exchange St, Suite 400
                                                                                                                                Astoria OR 97103
       7 Coast Rehab -                Vicki O'Brien - Contact    503-861-3372              vickio@coastrehab.org                65 N. Highway 101, Ste. 205
           Clatsop County             Bonnie Beadles-Bohling      503-861-3476      Fax    amybonnie@comcast.net                Warrenton, OR 97146
       8 Coast Rehab Services -       Bonnie Beadles-Bohling     503-491-5005       104    Amybonnie@comcast.net                333 SE 223rd, Ste. 103
           Multnomah County                                       971-219-6244      Cell                                        Gresham, OR 97080
       9 Columbia County DD           Corissa Neufeldt            503 397 5211             CorissaN@ccmh1.com                   105 S 3rd St
                                      LynnNolting                                          Lynnan@ccmh1.com                     St. Helens OR 97051
     10 Community Access              Arlene Baksay              503-533-4373              arlene@CAS-DD.org                    2123 NW Aloclek Dr., Ste. 1203
        Services                      Kathy Haines                                         kathy@CAS-DD.org                     Hillsboro, OR 97123
     11 CSI -                         Carol Baron                503-648-6415              cbaron@cs-inc.org                    1982 NE 25th Ave., #1
           Community Services, Inc.                              503-204-9301       Pgr                                         Hillsboro, OR 97124
     12 Community Vision              Jeff Hoofard               503-292-4964       103    jhoofard@hotmail.com                 1750 SW Skyline Blvd., Ste. 102
                                                                                                                                Portland, OR 97221
     13 D.S.I. - Developmental        Meridith Wexler            503-258-2440       104    meridith.wexler@thementornetwork.com 100
                                                                                                                     305 NE 102nd, Ste.
           Systems, Inc.                                                            101                                         Portland, OR 97220
     15 Eastco Diversified            Susan Norman               503-667-0613              snorman4@eastcodiversifiedservices.com
                                                                                                                     PO Box 470
        Services                                                cell 503-309-2456                                               Gresham, OR 97030




Revised 7/21/2010                                                                                                                                         Page 13
                                                                   Region 1
                                                            DD Training Co-Op
             UPDATED 6/15/05 Robyn Hoffman
                  MEMBER            CONTACT
                                                                Members
                                                             PHONE # EXT                           E-MAIL                              ADDRESS
       16 Good Shepherd               Kelly Thran            503-261-0255            kthran@gscommunities.org              7931 Halsey St., Ste. 305
          Communities                                         503-261-0259    Fax                                          Portland, OR 97213
       17 Goodwill Industries         Becki Martin           503-238-6199            bmartin@gicw.org                      1943 SE 6th Ave.
                                                                                                                           Portland, OR 97214
       18 Inclusion, Inc.             May Nelson             503-232-2289     12     may@inclusioninc.org                  3454 SE Powell Blvd.
                                                                                                                           Portland, OR 97202
       19 I.S.N. - Integrated         Cindy Nofield          503-325-0241     30     cshuler@seasurf.net                   #10 6th St., Ste. 103
             Services Network         Joyce Rangila x50       503-338-8176    Cell   jrangila@seasurf.net                  Astoria, OR 97103
*New   20 Mt. Angel Training Center   Rick Newton            503-845-9214            rckne3@aol.com                        PO Box 78
          & Residential Services                                                     jobdev@mtangel.net         Mt. Angel, Oregon 97362
       21 Multnomah County DD         Geneale Turner         503-988-3658 28597 geneale.turner@co.multnomah.or.us
                                                                                                                421 SW 6th
          Services                                                                                              Portland, OR 97204
       22 OESCO                       Mary Ellen Baldauff    503-774-1667            maryellenb@oescorp.org                PO Box 82698
                                                             503-288-5855                                                  Portland, OR 97282

       23
*New App.    Port City Development    Rose Hart              503-236-9515            info@portcitydevelopment.org          2124 N. Williams Ave.
             Center                                                          and/or> Carlos@portcitydevelopment.org        Portland OR 97227
                                                             5
                                      Regina Kalandros-Simmons 03 890 0157           artprogram@portcitydevelopment.org
       24 Portland Metro              Kathy Nelson           503-777-0805            KappyNelson@msn.com                   7940 SE Division, #C
          Residential Services        Mei Louie                                      MeiLouie@msn.com                      Portland, OR 97206
       25 Rainbow Adult Living        Mary Brottlower        503-287-5100            rainbowadultliving@msn.com            520 SE 29th
                                      Paula Kerns             503-232-0394    28     pjkerns@msn.com                       Portland, OR 97214
       26 Region I Crisis             Robin Wiggin           503-988-3703     222    robin.g.wiggin@co.multnomah.or.us     4850 SW Scholls Ferry Rd., #104
             Diversion Office                                                                                              Portland, OR 97225
       27 Riverside Training          Cindy Stockton         503-397-1922            cindy.stockton@riversidecenters.com   PO Box D
          Centers, Inc.                                                                                                    105 Port Ave.
                                                                                                                           St. Helens, OR 97051
       28 S.D.R.I. -                  Wendy Taliafero        503-292-7142            wendy@sdri-pdx.org                    1730 SW Skyline Blvd., Ste. 127
             Self Determination       Michael Gmirkin                                michael@sdri-pdx.org                  Portland, OR 97221




  Revised 7/21/2010                                                                                                                                    Page 14
                                                          Region 1
                                                     DD Training Co-Op
           UPDATED 6/15/05 Robyn Hoffman
                MEMBER            CONTACT
                                                         Members
                                                      PHONE # EXT                  E-MAIL                         ADDRESS
           Resources, Inc.
     29 Senior Center Project -    Jane Doyle        503-823-4328   jdoyle@ci.portland.or.us            426 NE 12th
           Portland Parks & Rec.                     Fax 823-4329                                       Portland, OR 97232
     30 SERP Enterprises           Judith Drescher   503-232-0927   judy@serpenterprises.com            2514 SE 23rd Ave.
                                                                                                        Portland, OR 97202
     31 Tualatin Valley            Darvin Pierce     503-649-8571   dpierce@tv-workshop.com             6615 SE Alexander
        Workshop, Inc.                                                                                  Hillsboro, OR 97123
     32 Up & Out Inc.              Renee Kibbee      503 796-0241   MyTwtee@aol.com                     521 SW 11th #304
                                   Kathy Kirby                      (pending email address)             Portland OR 97205
     33 Washington County DD       Jerri Rudacil     503-846-5743   jerri_rudacil@co.washington.or.us   3700 SW Murray Blvd., Ste. 300
                                                                                                        Beaverton OR 97006
     34 Westside Community Focus Mike Sanderson      503-731-0658   mistev82@comcast.net                700 SE Clay St
                                                                                                        Portland, OR 97214




Revised 7/21/2010                                                                                                              Page 15
Revised 7/21/2010                                                                                                   Page 16
                              CO-OP INSTRUCTORS COURSES
         Resource Info: Instructors / Course Topics

  The following is a list of instructors for training classes that have been taught in the past
  for the Regional Training Program (particularly the former Region II). It is a useful resource
   for reference only. It should not be considered up to date. The list is not necessarily in
  alphabetical order. Prices listed below are not indicative of current charges.If you have other
  suggested resources please contact the Keeper and request info be added to this for Host Kit.
  Thanks!

  Mitch Teal
  The Arc of Oregon
  1745 State Street
  Salem, OR 97301
  1-877-581-2726 Toll Free

  Mitch provides a powerpoint presentation on “The Oregon Special Needs Trust”. It is
  scheduled typically for a two hour time frame which includes questions and answers.
  Equipment needs: Screen (not vital)
  Handouts: Mitch will bring packets, but needs to have accurate head-count prior to
  training.
  Fee: No fee.

  DHS - Seniors & People w/Disabilities
  Office of Licensing and Quality Care
  Attn: (Insert Local Health Support Unit - DD RN’s here)
  500 Summer Street NE, #E13
  Salem, OR 97301
  Anne Christofferson, RN - 503-947-4223
  Helen Emmons, RN - 503-947-4229 or 503-731-3088 xt 62 (local)
  Helena Haddad, RN - 503-945-9797
  DD RN‟s have taught “The Fatal Four” in a four and a six hour format. “Medication Admin-
  istration” can be done in a two hour format.
  Equipment needs: Overhead projector, screen for slides.
  Handouts: Coordinator is responsible for making handouts, preferably in packet form.
  Special needs: A sign in sheet with a category for people to write in what job they
  perform.
  Fee: No fee.




  Jill Foreman
  Epilepsy Association of Oregon
  619 SW 11th, Suite 225
  Portland, OR 97205-2646
  503-228-7651
  Jill teaches “Brainstorms: Seizure Causes, Effect and Control” in a 2.5 hour or more
  format. Prefers to do longer, but can do shorter if absolutely necessary.
* Equipment needs: TV/VCR.
  If you get any corrections or new information on the listed instructors and their classes, please contact the Keeper so we
                                          can update the
  Handouts: Jill will bring packets, but needsrecords for everyone.
                                                            accurate headcount prior to class.
               will bring packets, but needs accurate headcount prior to class.
  Handouts: Jill
Revised 7/21/2010                                                                                                   Page 17
                       CO-OP INSTRUCTORS COURSES
  Fee: $100.00 for the training.

  Miriam Berman
  6224 SE Main St.
  Portland, OR 97215
  503-234-3785

  Miriam has a Masters in Deaf Ed. and Special Ed. She teaches Sign Language I,
  Sign Language II. She also has a child diagnosed recently with autism and is an
  ardent advocate for supports of that group.


  OTAC (Oregon Technical Assistance Group)
  3886 Beverly Ave. NE, Suite I-21
  Salem, OR 97305
  503-364-9943 xt 23 - Contact Kelly Gordham

  “Autism Awareness”, “OIS”, and other classes for technical supports. Times vary
  as well as equipment needs and prices.

   OIS "Mentor"Trainers (authorized to teach OIS statewide):
  current 12/04
  John Mushlitz - 503-317-5880
  Julie Beaton - 503-481-5172
  Mike Larson - 503-988-3703 xt 231
  Trish McConaughey -
  Carol Dinsmore - 503-262-0158




  John Mushlitz, Jr., Consultant
  Functional Alternatives (And also with Sindelar Care)
  10261 SE Insley
  Portland, OR 97266
  503-762-5063 (Office)
  503-317-5880 (Cell)

  Freelance “Oregon Intervention System (OIS)” instructor. This is a two day, fourteen
  hour class.
  Equipment needs: Wipe board and/or flip chart, markers.
  Handouts: John provides handouts, Coordinator will need to make copies.
  Fee: $600.00.



* If you get any corrections or new information on the listed instructors and their classes, please contact the Keeper so we
                                           can update the records for everyone.
Revised 7/21/2010                                                                                  Page 18
  George Hall, MSSW CO-OP INSTRUCTORS                             COURSES
  P.O. Box 989
  Mt. Angel, OR 97362
  503-845-4333
  503-316-3030 - Pager / Voice Mail

  George lectures on “Brain Function”, “Personality Attachment Disorder”, “Positive
  Programming for People With Sexually Aggressive Behavior”. He typically does a 6 hour
  seminar from 9 to 4.
  Equipment needs: Overhead, wipe board, markers.
  Handouts: Will provide handout for Coordinator to copy.
  Fee: About $75.00 an hour plus 35¢ a mile.

  Geri Newton, Consultant
  P.O. Box 4106
  Salem, OR 97302-8106
  503-363-6347
  Geri does a variety of six hour workshops; “Something Painless for Parents” and
  “Sexuality and Autism”. Her class are 6 hours from 9 to 4 and 1 hour break for lunch.
  Equipment needs: Depends on class. Usually just a wipe board, markers and some-
  times an overhead.
  Special needs: Prefers Fridays for training if possible.
  Handouts: Coordinator is responsible.
  Fee: About $750.00 - $800.00 for six hour workshop.

  Lisa Lieberman, MSW, LCSW
  15100 SW Boones Ferry Rd., Suite 750
  Lake Oswego, OR 97035
  503-697-5956
  Lisa does counseling and psychotherapy. She has a son with autism and a husband
  with MS. She does a two and a quarter hour forum entitled “My Child is Different and
  Sometimes It Hurts…” for parents. She also does couples counseling mostly to support
  parents and siblings of autistic children, “Living with Disability in the Family”. Also adults
  with autism. Classes are 2 to 2.5 hours.
  Equipment needs: Mostly does powerpoint (depending on topic) so needs projector.
  Also does overhead in some cases.
  Handouts: Coordinator is responsible. Please get updated versions.
  Special needs: Needs help with scheduling. Likes to know who audience is, and if
  possible, what types of disability their children are experiencing. She likes copies
  of the flyer advertising the class as she also does marketing for the class.
  Fee: About $100.00. an hour depending on topic.

  Kori Brooks
  6894 SE Fern Ave.
  Portland, OR 97206
  503-771-3298
  dkbrooks@spiritone.com
  Kori teaches “Rights of Individuals with Disabilities”, a 3 hour class. She may be available for
  other topics too, by netotiation.
  Equipment needs: Wipeboard with markers, or large easel with paper, markers and tape.
  Handouts: She will furnish information to coordinator who will make copies.
* If you get any corrections or new information on the listed 3 hour class).
  Fees: $20.00 per teaching hour ($60.00 per instructors and their classes, please contact the Keeper so we
                                     can update the records for everyone.
Revised 7/21/2010                                                                                                   Page 19
                              CO-OP INSTRUCTORS COURSES




  Mike Larson, Consultant
  Region I Crisis Diversion
  4850 SW Scholls Ferry Road, Suite 104
  Portland, OR 97225
  503-988-3703 ext 231
  Also:
  David Langlois - 503-988-3703 ext 235
  Jane Rake - 503-493-9383

  Mike provides “Autism Awareness” amd “Autism Level 2”. Times vary. Best not to
  shrink into two hour class. Though Mike is willing to do a shorter class, the audience
  is left thirsting for more.
  David teaches the same as Mike and also does “OIS”.
  Jane is an autism/asberger‟s syndrome specialist.
  Equipment needs: Wipe board, markers.
  Handouts: Mike brings handouts.
  Fee: Varies according to time. About $75.00 an hour.

  Tony Farrenkopf, PH.D.
  Clinical Psychology
  2256 NW Pettygrove
  Portland, OR 97210
  503-225-0498 / Fax 503-225-0499

  Clinical and Forensic Psychologist for 27 years. Most important classes he likes
  to teach are “Victimization Prevention and Abuse Survival and Recovery” (for victims)
  which is a combo class), “Sexual Abuse Prevention” (for abusers), “Victimization
  Prevention” (for victims), “Abuse Survival and Recovery”, and “Burnout Prevention
  Vicarious Traumatization” (for staff). Classes: 1/2 day is 3 to 3.5hr workshop which
  includes question/answer time and a 15 minute break.
  Equipment needs: Wipeboard or Flip board with markers.
  Handouts: He will provide original info and host coordinator will make copies.
  Special needs: He likes Fridays, either a.m or p.m.
  Fees: $390.00 for 3 hour class, $450.00 for 3.5 hour class.




  Steve Smith, Attorney
  Smith & McDonald LLP
  1100 SW 6th Ave., Suite 1504
* If you get any corrections or new information on the listed instructors and their classes, please contact the Keeper so we
  Portland, OR 97204                      can update the records for everyone.
  503-248-9535
  Portland, OR 97204
Revised 7/21/2010                                                                                                   Page 20
  503-248-9535                CO-OP INSTRUCTORS COURSES
  Steve provides “Wills, Trusts, and Guardianships”, typically two hour formatted,
  but with allowance for some overtime if lots of questions.
  Equipment needs: Wipe boards and markers.
  Handouts: Steve brings, but needs an updated number as well as who audience
  is comprised of.
  Fee: No fee.

  Meg Nightingale
  5416 SW Matha Terrace
  Portland, OR 97201
  503-768-3903

  Meg does a variety of different half-day workshops such as “Guardianship and
  Alternatives to Guardianship”, “ADA” and “Conflict Resolution”.
  Equipment needs: Wipe board, varies upon topic.
  Handouts: Coordinator is responsible.
  Fee: Roughly $150.00 an hour.


  Lori Thompson, Consultant
  Specialized Consultation Services
  P.O. Box 42658
  Portland, OR 97242
  503-232-2176
  Lori has a variety of topics, but a popular class is about aging issues in relation
  to Down‟s Syndrome.
  Equipment needs: Check with Lori.
  Handouts: Coordinator is responsible.
  Special needs: Advanced scheduling, follow-up and confirmation.
  Fee: Was $400.00 half day, $800.00 full day (in „98). Prices have most likely
  increased.




  Robin Wiggin
  Region 1 Crisis Diversion Office
  4850 SW Scholls Ferry Rd., Suite 104
  Portland, OR 97225
  503-988-3703 xt 222
  Robin provides “Introduction to Developmental Disabilities” in a six hour format with 1-2 co-
  teachers. Also Basic Money Management in a 4-hour format.
  Equipment needs: Overhead, TV/VCR (for Intro only).
  Handouts: Robin can usually bring packets copied, but will need to charge 5cents/side for that,
  or host can make copies from advance original.
  Special needs for Intro: Sturdy table in front with chairs, wall space for hanging posters.
  Fee: No fee.

  Julie Snook, Consultant
* If you get any corrections or new information on the listed instructors and their classes, please contact the Keeper so we
  Portland, OR 97206                       can update the records for everyone.
  Portland, OR 97206
Revised 7/21/2010                                                                                           Page 21
                       CO-OP
  503-975-6649 or 771-0383               INSTRUCTORS COURSES
  Julie provides several workshops, most related to advanced behavior supports
  such as “Intermediate Behavior Strategies” (“Behavior 2”) and “Advanced Behavior
  Strategies” (“Behavior 3”. Also “Real Work for People with Challenging Behaviors”.
  Equipment needs: Usually an overhead, wipe board, but sometimes other needs.
  Handouts: Coordinator is responsible.
  Fee: $450.00 per day.

  Robin Rose, Consultant
  2745 105th Ave. NE
  Salem, OR 97301
  503-873-3649
  RKRose@worldnet.att.net
  Robin provides six hour workshop son various topics relating to working with
  people, having positive attitudes, learning stress management techniques, etc.
  Very popular speaker.
  Equipment needs: Overhead, flip chart, markers.
  Handouts: Coordinator is responsible.
  Fee: About $1,200.00 for six hour lecture.




  Nyla McCarthy, Training Program Manager
  Office of Investigations and Training (DHS)
  2575 Bittern St. NE
  P.O. Box 14250
  Salem, OR 97309
  503-947-4221 Nyla.A.McCarthy@state.or.us

  Nyla offers “Protective Services/Mandatory Abuse Reporting” classes, as well as
  “Conflict Management”. These are typically 2 - 3 hour formats.
  Equipment needs: Overhead, wipe board, markers.
  Handouts: Ask Nyla.
  Fee: No fee.

  Tom Zaner
  Protective Services
  998 Library Ct.
  Oregon City, OR 97045
  503-723-4868
  Tom provides an “Understanding Protective Services and Required Reporting”
  class, about an hour and a half in length.
  Equipment needs: None.
  Handouts: Tom provides.
  Fee: No fee.

  Lee Greer, Consultant
  727 SE 32nd
* Portland, OR 97214 or new information on the listed instructors and their classes, please contact the Keeper so we
  If you get any corrections
  503-239-8569                    can update the records for everyone.
  503-239-8569
Revised 7/21/2010                                                                                                   Page 22
  leegreer@fastmail.fm CO-OP                INSTRUCTORS COURSES
  Lee offers several different classes, among them “The Ethics of Touch”, a six hour
  seminar based on video tapes of Dave Hingsburger; “Behavior 1”, a four hour class,.
  Equipment needs: Depends on the topic, typically a wipe board, markers.
  Handouts: Coordinator is responsible.
  Fee: Typically about $75.00 an hour.




  Diane Malbin
  FASCETS
  Fetal Alcohol Syn. Consultation, Education
  and Training Svcs, Inc.
  15500 NW Ferry Road, #L - Address needs verification
  Portland, OR 97231-1331
  503-621-1271 or cell 503-888-2107

  Diane instructs on “Understanding Fetal Alcohol Syndrome”. While this can be
  presented in a three hour format, it is highly recommended to have her do a longer
  presentation. High audience response.
  Equipment needs: Overhead, overhead transparency sheets, overhead markers, slide
  projector and screen, TV/VCR and wipe board.
  Handouts: Coordinator makes the copies.
  Fee: About $1,500.00 for a six hour seminar.


  Tammy Bradley
  Regional Assistant
  Oregon Parent Training and Information Center
  1745 State St.
  Salem, OR 97301
  1-888-505-2673
  503-642-0226 - Tammy’s Local Number
  Tammy presents two hour (with extra time for overlap) workshops on various topics
  related to education for children with disabilities; “IEP”, “Transition” and “Transition
  to Kindergarten”, etc.
  Equipment needs: Tammy brings a powerpoint presentation.
  Handouts: Tammy will bring, or for collaboration, coordinator can offer to help.
  Fee: No fee.


  Lori LeDuc
  Washington County DD
  503-846-5750
  Teaches “Disability Awareness”.
  Fee: None.


* If you get any corrections or new information on the listed instructors and their classes, please contact the Keeper so we
                                           can update the records for everyone.
Revised 7/21/2010                                                                                                   Page 23
  Jami Cloghessy
                              CO-OP INSTRUCTORS COURSES
  10660 SW Dazies, #42
  Beaverton, OR 97008
  503-372-5886
  Specializes in conflict resolution, communication. Teaches "Clients are Easy, Staff is What's
  Hard", a 2-3 hour course.
  Fee: $35.00 an hour.

  Mike Malchow-Hay
  4026 NE 39th
  Portland, OR 97212
  503-281-3634
  Teaches on "Medical Record Keeping". Long time Rainbow Adult Living staff member.

  Steve Tate, RN
  Coast Rehab -
  503-491-5005 xt 103
  Former instructor for Fatal Four when was RN for State DD.

  Burton Silverman, psychiatrist
  503-644-1171
  Teaches on "Psychotropic Drugs".
  Cost unkown.




* If you get any corrections or new information on the listed instructors and their classes, please contact the Keeper so we
                                           can update the records for everyone.
              Riverside Training Centers, Inc.
          as part of the Region 1 DD Training Co-op offers:

                Personality Disorders
                 by Dr. James Clay, Psy D.
                 Monday October 10, 2005
                      9 a.m. - 1:00 p.m.
             at The Kennedy School (McMenamins)
              5736 NE 33rd, Portland OR 97211
    $15.00 for coop members/$30.00 for non members
* Foster care & families always get member rate but rate DOUBLES if registrant is not
                      affiliated with a Co-Op Member/agency)


          A fun and participatory opportunity to delve into the
         challenges faced in providing support to people with a
     diagnosis of mental retardation and a personality disorder and
                   how to best provide that support.

               We can accept cash, check or money orders
                payable to Riverside Training Centers, Inc.
                        Send Registrations to:
                       Riverside Training Centers, Inc.
                       PO Box D, St Helens, OR 97051
                        503.397.1922/503.397.1527 fax
                        cindy.stockton@riversidecenters.com
                            REGISTRATION & PAYMENT FORM


Name of Class Participant              Contact Phone Number(s)         Contact E-mail Address

Agency Name                                 Mailing address                 City            Zip

Name of Class: Personality Disorders                             Date: Monday October 10, 2005

CLASS FEE $15.00 member/$30.00 non-member


 payable to “Riverside Training Centers, Inc.


Amount enclosed: $_____

Mail this form & payment to: Cindy Stockton, PO Box D, St Helens, OR 97051
Registrations limited to the first 50 individuals. No reminders of class registration will be sent.
No refunds of registration fee will be offered. We appreciate your effort to make any needed
advance arrangements to attend.



                            REGISTRATION & PAYMENT FORM



Name of Class Participant              Contact Phone Number(s)         Contact E-mail Address

Agency Name                                 Mailing address                 City            Zip

                                                       Date: Monday October 10, 2005
Name of Class: _Personality Disorders__________________________

CLASS FEE $15.00 member/$30.00 non-member


 payable to “Riverside Training Centers, Inc.



Amount enclosed: $_____

Mail this form & payment to: Cindy Stockton, PO Box D, St Helens, OR 97051
Registrations limited to the first 50 individuals. No reminders of class registration will be sent.
No refunds of registration fee will be offered. We appreciate your effort to make any needed
advance arrangements to attend.

				
DOCUMENT INFO
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