Registration for Children Who Challenge (PDF) (WORD DOC)
REGISTRATION LIMITED
THE EASY WAY!!!!! go to our website www.familiestogether.org and click on register now.
OR YOU CAN COMPLETE AND MAIL/FAX THIS FORM.
FTPD - C. Clark Phone us to register at 1-866-326-4864
4417 Great Oak Road OR FAX: 1-509-335-7339
Rockville MD 20853
NAME:____________________________________________________
ADDRESS:_________________________________________________
CITY: _______________________________STATE_______ZIP___________
PHONE: ___________________________ Email:__________________________________
All attendees must register and will receive an email confirmation. All proceeds will be used to directly benefit families who have a child with a disability. Refunds under most circumstances are not allowed. Substitutions are always allowed. Please remind your substitute to bring the confirmation letter. Donation registrations for parent scholarships are always appreciated. Please call 1-866-326-4864 if you do not receive a confirmation notice or you have any other questions. CEUs will be available for an both days for an additional charge.
WORKSHOP ON BEHAVIOR Children Who Challenge
_____ $60.00 Companion Workshop on Behavior
_____ $14.00 for 7 CEUS for Feb 18
Total Paid ___________
HOW ARE YOU PAYING?
___I am paying by check . Make checks payable to Families Together for People with Disabilities
___I have enclosed a check or money order for _______
____I am paying the registration fee using a credit card.
1. Click here to register and pay on line Register Now
2. You may also fax your credit card info to: 509-335-7339
Charge my: (circle one) -----Master Card ----Visa. (American Express can only be used on Acteva)
Account No. ____________________________Exp. Date______________
Name: _____________________________________
Address: ___________________________________
**If paying by credit card, please use name and address to which your credit card bill is mailed.
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