WORKSHOP REGISTRATION FORM
N
DHHS 8th Annual Working Together Conference
Transition: Planning to Succeed
F
riday October 3,
2008
8:00
am
to
4:
3
0pm
Location: T
he Radisson Hotel at the Center of NH
7
00 Elm Street, Manchester NH
Your name:
Agency/School:
Position:
Address:
City/State/Zip:
Your email address:
Phone number (v/vp/tty):
Click here if you are a parent of a deaf/hard of hearing child:
Child's school:
Child's grade:
**There are a limited number of scholarships available for parents**
Workshop:
Fee
Registration
-
All day (includes lunch)
$90
Registration-Half day (Lunch NOT included) $40
Registration deadline: September 24, 2008
Refund Policy:
Refunds will be given (minus a $25 administration fee) if cancellation is received prior
to September 24, 2008.
No refunds will be given for cancellations received after September 24, 2008
To register:
Complete online registration form and click submit or print and mail to:
NDHHS
57 Regional Drive
Concord NH 03301
Attn:
Working Together Conference Registration
Payment:
Checks payable to NDHHS or credit card (please fill out fields below)
Questions about the workshops or registration? Please contact Kim Pelkey at (603) 224-1850 ext 209,
vp (603) 224-0209 or kpelkey@ndhhs.org
We can only accept
MC or VISA
MC
VISA
Credit card number:
Expiration date:
Communication Access
ASL interpreters, CART and
assistive listening
devices will be available. Please let us know if
you have other access needs.
Comments or questions: