registration for 2009 trainings

1. Registration for 2009 training events

The Illinois Adult Day Service Association is pleased to offer the following training sessions with support and funding from the Illinois Department on Aging.

Please complete a SEPARATE REGISTRATION for EACH PERSON.
Note that a several additional items are required if you are registering for MCT and/or TADS.
If payment is required...you may register on line but it will not be processed until payment is received. Mail check to

Pat Stacy Cohen
Illinois Adult Day Service Association
6141 N. Cicero
Chicago, Illinois 60646

REGISTRATION DEADLINE IS APRIL 6, 2009

1. Please print your email CLEARLY as it is our primary means of follow-up.

Please print your email CLEARLY as it is our primary means of follow-up. Name:
Center/Agency
Address:
agency phone
City/Town:
ZIP code
Email Address:
Phone Number:

2. Please indicate your agency status.

	yes	no
I am a current CCP contracted adult day service provider.	Please indicate your agency status. I am a current CCP contracted adult day service provider. yes	no
I am a member of IADSA	I am a member of IADSA yes	no

3. I plan to attend the PROGRAM ASSISTANT TRAINING in the following location.

I plan to attend the PROGRAM ASSISTANT TRAINING in the following location. PROGRAM ASSISTANT TRAINING, AFCC in Chicago, May 6, 13, 20,27, 2009

PROGRAM ASSISTANT TRAINING, AFCC in Chicago June 9, 16, 23, 30 (Tuesdays)