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 Attendee Registration Form

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.

Name Title

Organization Name

Address

City ST Zip

Phone Fax Email

Designation (use one of the following)

Abbreviation	Designation Title	Abbreviation	Designation Title
FP	Foster Parent	LPC	Lic. Prof. Couns.
SW	Social Worker	OC	Other Clinician
S	Student	Other	All Others

I would like CEUs (Y/N)

Foster Parents: I will be attending: (place a Y next to the day(s) you will be attending)

Full Conference Wed Thurs Fri

All Registrants: I will be attending:

Banquet (Wed., Oct. 2) (Y/N)

Luncheon (Thurs., Oct. 3) (Y/N)

Total Due*:

*Clinicians: your registration fee includes the luncheon and banquet. All other registrants must pay the additional fees if they would like to attend the other events.

Or Print a Registration Form to fill in and Fax

Registration Fees:

Clinician:

(Before 9/20): $95.00

(After 9/20): $115.00

CEUs: $10.00 (additional charge)

Foster Parent: (include a copy of your license with payment)

Full Conference: $30.00

One or more days: $10.00 each day

Student: $25.00 (include a copy of your school ID with payment)

(*Luncheon and Banquet are included in Clinician registration)

Banquet (Wed., Oct. 2, 2002, 6:00 p.m.)

$27.00

Luncheon (Thur., Oct. 3, 2002, 12:00 p.m.)

$20.00

Payment must be received by September 20, 2002 to qualify for early registration rate.

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

You will receive a confirmation notice by 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

FYI-Conference starts at Noon, Oct. 2 and ends at Noon, Oct. 4. Go to the conference home page for accommodations and other valuable information.

Email: ATFCPA

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