| Conference Registration |
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COST: $125
____My check or money order is enclosed.
____ I wish to pay on-site ($3.00) surcharge applies)
____ I wish to have a vegetarian lunch
Conference sponsorship opportunities
are available. For more information,
contact (317) 923-3930
____My check or money order is enclosed.
____ I wish to pay on-site ($3.00) surcharge applies)
____ I wish to have a vegetarian lunch
Conference sponsorship opportunities
are available. For more information,
contact (317) 923-3930
COST: $125
____My check or money order is enclosed.
____ I wish to pay on-site ($3.00) surcharge applies)
____ I wish to have a vegetarian lunch
Conference sponsorship opportunities
are available. For more information,
contact (317) 923-3930
____My check or money order is enclosed.
____ I wish to pay on-site ($3.00) surcharge applies)
____ I wish to have a vegetarian lunch
Conference sponsorship opportunities
are available. For more information,
contact (317) 923-3930
| Registration Form |
________________________________________________________________
.Attendes Name
________________________________________________________________
Organization
________________________________________________________________
Address
________________________________________________________________
City, State, Zip Code
________________________________________________________________
Phone Number Fax Number
________________________________________________________________
Contact Person's E Mail Address
To attend, please fill out this form and mail to:
P.O. Box 88788, Indianapolis, IN 46205 or fax to 317-923-2441
Make checks payable to IMMHPA
For questions, please call 317-923-3930
Please make check or money order payable to IMMHPA
For more information contact Carolyn at (317) 923-3930 or mscarolyn@sbcglobal.net
P.O. Box 88788, Indianapolis, IN 46205 or fax to 317-923-2441
Make checks payable to IMMHPA
For questions, please call 317-923-3930
Please make check or money order payable to IMMHPA
For more information contact Carolyn at (317) 923-3930 or mscarolyn@sbcglobal.net
COST: $99
4 agency staff - $79.00/each
Student: $25.00
CEU’s/CLE’s: $10
____My check or money order is enclosed.
____ I wish to pay on-site ($3.00) surcharge applies)
Conference sponsorship opportunities are available.
For more information,contact (317) 923-3930
4 agency staff - $79.00/each
Student: $25.00
CEU’s/CLE’s: $10
____My check or money order is enclosed.
____ I wish to pay on-site ($3.00) surcharge applies)
Conference sponsorship opportunities are available.
For more information,contact (317) 923-3930