World Elder Abuse Awareness Day Seminar Individual Registration Form
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WORLD ELDER ABUSE AWARENESS DAY SEMINAR INDIVIDUAL REGISTRATION FORM ORGANIZATIONS SENDING 5 OR MORE EMPLOYEES SHOULD USE THE ORGANIZATION REGISTRATION FORM
EVENT INFORMATION: DATE TIME LOCATION -
REGISTRATION FEES:
MONDAY, JUNE 15, 2009 7:30 AM – 4:00 PM NORTH SHORE HARBOR CENTER 100 HARBOR CENTER BLVD. SLIDELL, LA 70461
CASH OR CHECK ONLY BASIC1 PROFESSIONAL
2
TIMELY
LATE
ON/BEFORE MAY 23RD
MAY 23JUNE 10
O NSITE
$30.00
$40.00
$50.00
$50.00
$65.00
$75.00
1
BASIC – THIS LEVEL IS NOT ELIGIBLE FOR CONTINUING EDUCATION CREDIT PROFESSIONAL – THIS LEVEL IS APPLYING FOR CONTINUING EDUCATION CREDIT FROM THE LOUISIANA DISTRICT ATTORNEYS ASSOCIATION (APPROVAL PENDING) OR THE LOUISIANA CHAPTER OF THE NATIONAL ASSOCIATION OF SOCIAL WORKERS (THIS PROGRAM WAS APPROVED FOR 6.0 GENERAL CONTACT HOUR(S) OF CONTINUING EDUCATION CREDIT BY THE NATIONAL ASSOCIATION OF SOCIAL WORKERS—LOUISIANA CHAPTER AS AUTHORIZED BY THE LOUISIANA STATE BOARD OF SOCIAL WORK EXAMINERS). NOTE: IT IS THE RESPONSIBILITY OF THE ATTENDEE TO KNOW IF S/HE IS ELIGIBLE FOR CONTINUING EDUCATION CREDIT. REFUNDS WILL NOT BE AUTHORIZED IF THE ATTENDEE ERRS BY APPLYING WHEN INELIGIBLE. 2
REGISTRATIONS POSTMARKED ON OR BEFORE MAY 23RD WILL BE TIMELY. REGISTRATIONS POSTMARKED FROM MAY 24TH TO JUNE 10TH WILL BE CONSIDERED LATE. ALL REGISTRATIONS POSTMARKED AFTER JUNE 10TH WILL BE ON SITE REGISTRATIONS. CANCELLATION POLICY: CANCELLATIONS POSTMARKED BEFORE MAY 1, 2009 WILL BE REFUNDED IN FULL. REQUESTS POSTMARKED MAY 1-MAY 23 WILL RECEIVE A 50% REFUND. THERE WILL BE NO REFUNDS FOR CANCELLATIONS POSTMARKED ON OR AFTER MAY 24, 2009.
REGISTRANT INFORMATION PLEASE PRINT REGISTRATION TYPE (MARK CORRECT BOX) BASIC PROFESSIONAL NASW-LA LDAA NAME: _____________________________________________________________________________________ MAILING ADDRESS: ___________________________________________________________________________ STREET OR PO BOX
________________________________________________________ CITY
_______ STATE
____________________ ZIP CODE
CONTACT PHONE: _________________________ E-MAIL: __________________________________________ Mail to: St. Tammany SALT Council PO Box 596 Mandeville, LA 70470-0596 ST. TAMMANY SALT COUNCIL
PHONE: 985-809-5450
E-MAIL: [email protected]
EVENT INFORMATION: DATE TIME LOCATION -
REGISTRATION FEES:
MONDAY, JUNE 15, 2009 7:30 AM – 4:00 PM NORTH SHORE HARBOR CENTER 100 HARBOR CENTER BLVD. SLIDELL, LA 70461
CASH OR CHECK ONLY BASIC1 PROFESSIONAL
2
TIMELY
LATE
ON/BEFORE MAY 23RD
MAY 23JUNE 10
O NSITE
$30.00
$40.00
$50.00
$50.00
$65.00
$75.00
1
BASIC – THIS LEVEL IS NOT ELIGIBLE FOR CONTINUING EDUCATION CREDIT PROFESSIONAL – THIS LEVEL IS APPLYING FOR CONTINUING EDUCATION CREDIT FROM THE LOUISIANA DISTRICT ATTORNEYS ASSOCIATION (APPROVAL PENDING) OR THE LOUISIANA CHAPTER OF THE NATIONAL ASSOCIATION OF SOCIAL WORKERS (THIS PROGRAM WAS APPROVED FOR 6.0 GENERAL CONTACT HOUR(S) OF CONTINUING EDUCATION CREDIT BY THE NATIONAL ASSOCIATION OF SOCIAL WORKERS—LOUISIANA CHAPTER AS AUTHORIZED BY THE LOUISIANA STATE BOARD OF SOCIAL WORK EXAMINERS). NOTE: IT IS THE RESPONSIBILITY OF THE ATTENDEE TO KNOW IF S/HE IS ELIGIBLE FOR CONTINUING EDUCATION CREDIT. REFUNDS WILL NOT BE AUTHORIZED IF THE ATTENDEE ERRS BY APPLYING WHEN INELIGIBLE. 2
REGISTRATIONS POSTMARKED ON OR BEFORE MAY 23RD WILL BE TIMELY. REGISTRATIONS POSTMARKED FROM MAY 24TH TO JUNE 10TH WILL BE CONSIDERED LATE. ALL REGISTRATIONS POSTMARKED AFTER JUNE 10TH WILL BE ON SITE REGISTRATIONS. CANCELLATION POLICY: CANCELLATIONS POSTMARKED BEFORE MAY 1, 2009 WILL BE REFUNDED IN FULL. REQUESTS POSTMARKED MAY 1-MAY 23 WILL RECEIVE A 50% REFUND. THERE WILL BE NO REFUNDS FOR CANCELLATIONS POSTMARKED ON OR AFTER MAY 24, 2009.
REGISTRANT INFORMATION PLEASE PRINT REGISTRATION TYPE (MARK CORRECT BOX) BASIC PROFESSIONAL NASW-LA LDAA NAME: _____________________________________________________________________________________ MAILING ADDRESS: ___________________________________________________________________________ STREET OR PO BOX
________________________________________________________ CITY
_______ STATE
____________________ ZIP CODE
CONTACT PHONE: _________________________ E-MAIL: __________________________________________ Mail to: St. Tammany SALT Council PO Box 596 Mandeville, LA 70470-0596 ST. TAMMANY SALT COUNCIL
PHONE: 985-809-5450
E-MAIL: [email protected]
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