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Vocational
Implications of Psychiatric Disabilities:
Implications
of Mental Illness and Substance Abuse
July 16, 2008 - Bloomington, MN
or
July 21, 2008 - Chicago
or
July 30, 2008 - Columbus, OH
or
July 31, 2008 - East Lansing, MI
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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. 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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Yes, I want CRC credit.
Yes, I want CEUs. |
Please
select from the following:
July 16, 2008 - Bloomington, MN
July 21, 2008 - Chicago, IL
July 30, 2008 - Columbus, OH
July 31, 2008 - East Lansing, MI
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Please
select from the following:
$65 per participant (continental breakfast and lunch and
materials are provided.) |
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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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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