Thirteenth annual

REGISTRATION

Fee: Early registration is $50 per day, if received by October 10th. Registrations received after that date are $55 per day. The fee(s) are non-refundable.

CEUs: Social Work and Mental Health CEUs will be available. A $10 fee will be required for CEUs. Nursing contact hours will also be available, at no charge. For further information, please contact Anita at 1-508-271-0485.

Workshop Choices

Morning (101-106)

First Afternoon (201-206)

Second Afternoon (301-304)

Credits

Will you want to receive CEUs?

Will you want to receive RN hours?

Personal Information

First Name

Last Name

Agency

Address

Phone

E-mail

Additional comments

Registration Fee

Payment method

If paying by check: please make payable to "Shared Living Conference," and mail to:

Tammy Lamica

Shared Living Conference

P.O. Box 158

Sturbridge, MA 01566

If paying by credit card: please call Tammy Lamica at 1-800-541-6401 x133 or FAX at 1-508-347-3149