Sustaining Individualized Options  during Challenging Times

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REGISTRATION

Fee: Fee for registration is $50.00; for Family members $25.00.  The fee(s) are non-refundable.
CEUs:  Social Work and Mental Health CEUs will be available at no charge.  Nursing contact hours will also be available, at no charge.  For further information, please contact Anita  at 1-508-653-8724 x227.
Workshop Choices
Morning (101-104)	-------------- choose one ---------------- 101. Commissioners Roundtable 102. Aging 103. Adjusting to Family Life 104. Interactive Workshop
Afternoon (201-205)	-------------- choose one ---------------- 201. "When we say all people, do we mean all people?" 202. Basics of Special Needs Planning 203. Adult Family Care - A Community Based Living Option 204. Stress Management for Caregives 205. Empowering Providers - Partnering for Program Success
Credits
Will you want to receive CEUs?	-------------------------------- choose one -------------------------------- Yes No
Will you want to receive RN hours?	-------------------------------- choose one -------------------------------- Yes (available at no additional charge) No
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Personal Information
First Name
Last Name
Agency
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Phone
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Additional comments
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Registration Fee
Payment method	------------------------------- choose one ------------------------------- Check Credit Card Money Order Pay at Door
If paying by check:  please make payable to "Shared Living Conference," and mail to:      Connie Topor      Shared Living Conference      P.O. Box 158      Sturbridge, MA  01566
If paying by credit card: please call Connie Topor at 1-800-652-2201 x150 or FAX at 1-413-732-1168
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