Turn on the Lignt - Conference on Child Abuse and Neglect - Presented By The Children's Healing Institute

Presented by:

Questions?
(561) 585-1650
Fax (561) 585-4668

RETURN TO THE CHILDREN'S HEALING INSTITUTE HOME PAGE

EIGHTH ANNUAL SOUTH FLORIDA
Conference on Child Abuse and Neglect

GROUP ONLINE REGISTRATION
To take advantage of this group offer, registration and payments most be submitted at the one time.
If you have more than 10 people in your group, please submit multiple forms.

Agency, Organization or Business:

Contact Name:

Title:

Address:

City: ST: Zip:

Email:

Phone:

Fax:

We are registering prior to October 2 for $85 - Early Bird Discount ($95 after Oct.2)
Registration includes Continental Breakfast, Lunch and 3 Workshops

Group Information:

Employee Name: Title: Email:		Employee Name: Title: Email:

Employee Name: Title: Email:		Employee Name: Title: Email:

Employee Name: Title: Email:		Employee Name: Title: Email:

Employee Name: Title: Email:		Employee Name: Title: Email:

Employee Name: Title: Email:		Employee Name: Title: Email:

Yes, we have more employees to register. (Please submit another form after this one)

Payment Information:

Card Type:

Card Number:

Expiration Date:

/ (MM/YYYY)

Name on Card:

Credit Card Billing Address is the same as the Registration address.
If not, please enter the billing address below.

Billing Address:

City:

State:

Zip Code:

If you prefer to pay by check, please print our mail-in registration form and send it with your check to
The Children's Healing Institute | 1199 W Lantana Road | Lantana, Florida 33462

All Purchases are Final and Non Refundable.

For more information call,Suzan Santosus at (561) 585-1650 ext 101 or email: