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

NINTH ANNUAL SOUTH FLORIDA
Conference on Child Abuse and Neglect

SPONSOR ONLINE REGISTRATION
Our organization|agency|business is interested in supporting the conference as a sponsor.

Agency/Organization/Business:

Contact Name:

Title:

Address:

City: ST: Zip:

Email:

Phone:

Fax:

YES! We will email our corporate logo (eps format) to be recognized in all conference materials.

YES! We would like to have a resource table at the conference. (included with all sponsorship levels)

YES! The following person(s) will attend the conference as our representative:

1.	5.
2. (Sisters & Brothers include 2 registrations)	6. (Moms & Dads includes 6 registrations)
3. (Nieces & Nephews includes 3 registrations)	7.
4. (Aunts & Uncles includes 4 registrations)	8. (Grandparents includes 8 registrations & a reserved table at lunch)

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:

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If you prefer to pay by check, please download the registration form and mail it with your check.

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