Employment
Facilitation Certificate Program
Rick McAllister, Presenter
Chicago, IL
Session
I - April 18, 2008
and/or
Session
II - June 20, 2008
and/or
Session
III - July 25, 2008
and/or
Session
IV - August 15, 2008
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Registration
Form |
- Bold items are
required.
- Please send a
separate registration form for each participant.
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First
Name:
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Last Name:
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Job Title:
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Organization:
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Supervisor
Status:
No, I do not have a supervisor.
Yes, I have a supervisor (Please provide your supervisor's name, phone
number, and e-mail.)
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Mailing
Address1:
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Mailing
Address2:
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City:
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State:
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Zip:
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Phone (required):
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Fax:
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Email (required):
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| NOTE: If you do not
provide your email address and phone number we cannot confirm your registration.
Your space may not be held at the event.
Web site:
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Please check if you want to subscribe to the free electronic RSA Region
V listserv. |
Please check if you require special assistance to fully participate. Please
describe your needs in the box below.
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Please
select from the following:
April 18, 2008: $50.00 per participant ($40.00 APSE member).
June 20, 2008: $50.00 per participant ($40.00 APSE member).
July 25, 2008: $50.00 per participant ($40.00 APSE member).
August 15, 2008: $50.00 per participant ($40.00 APSE member).
Check here if multiple participants register for this training from
your agency and provide their names in the box below.
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Payment
Method:
Please make checks/purchase orders payable to the University
of Illinois.
Check in the mail.
Purchase Order. Please provide purchase order number.
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What other types of training
are of interest to you?
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Seating
is limited - register early!
If you are
having problems submitting this form online,
please
click
here to print and mail or fax form to:
RSA
Region V CRP-RCEP
Transition Research Institute
ATTN: Betty Taylor
117 Children's Research Center
51 Gerty Drive
Champaign, IL 61820
phone: 217-333-2325
TTY 217-244-7132
Fax 217-244-0851
http://www.ed.uiuc.edu/illinoisrcep
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