2002 Annual Therapeutic Foster Care Conference

Building Partnerships: Working Hand-in-Hand

October 2-4, 2002, Embassy Suites, Montgomery, AL

Sponsored by the Alabama Therapeutic Foster Care Providers Association (ATFCPA)

Online Exhibitor Registration Form: (Deadline has been extended to September 20, 2002 due to late mailing.)

FYI: When you hit Submit, you may receive a pop-up message asking if you would like to continue or cancel. Choose continue if you would like to complete your online registration.

Organization Name

Address

City ST Zip

Phone Email

Contact Person Title

Number of chairs needed at display Is display self-standing? (Y/N)

Will you need a table? (Y/N) Will you require electricity? (Y/N)

Will your exhibit have an agency representative present? (Y/N)

Will your agency offer a door prize to conference attendees? (Y/N)

Names and Titles of representatives as they are to be printed on name tags:

Name Title

Name Title

Name Title

Name of organization as it is to printed on table tent (one line only):

Require accommodations? (Y/N) Require directions? (Y/N)

Other needs

Payment must be received by September 25, 2002 to secure your registration.

Please send only checks, money orders, or purchase orders.

You will receive a confirmation notice by snail mail after September 25, 2002.

If you register online and do not receive an email acknowledgement within 24 hours, please email

Send payment to: (Please print a copy of this form for your records)

ATFCPA

C/O P.O. Box 70245

Montgomery, AL 36107

You may also fax this form to:

(334) 269-6314

For other information, contact:

(334) 220-6242

Email: ATFCPA

FYI-Planned exhibit setup time is after 8:00 a.m. on October 2, 2002. Conference starts at Noon, Oct. 2 and ends at Noon, Oct. 4. Go to the conference home page for accommodations and other valuable information.

Fee for 3 days is $250.00.

Make checks payable to: ATFCPA

Thank you for supporting Therapeutic Foster Care in Alabama.

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