REGISTRATION

* 1. First Name

* 2. Last Name

* 3. Title

* 4. Program/Organization

* 5. Email Address

* 6. Telephone

* 7. If you have needs that require a specific accommodation during the institute please list them here.

* 8. I would like to provide information about my agency/program/home business at an exhibit table for a fee of $10.

* 9. If this training is approved, I would like to receive ND Board of Social Work contact hours.

* 10. If this training is approved, I would like to receive Growing Futures hours. (These hours are for licensed child care providers).

Thank you for registering for the 2017 North Dakota Birth to Three Institute!

Social Work Contact Hours and Growing Futures Hours are currently pending.

Please note that registration confirmation WILL NOT be sent immediately upon submission of this online registration. Participants will receive a confirmation notice via email.

Please register by: May 30, 2017

Cost: $75 which includes a light breakfast, lunch, snacks and beverages

If you would like an invoice sent to you please contact Dawn Williams at email: ndhsa@ndheadstart.com or telephone (701) 237-6013.

Upon completion of this online registration form, please mail your registration fee to:

North Dakota Head Start Association
Attn: Dawn Williams
1326 1st Street North
Fargo, ND 58102

Please make checks payable to: North Dakota Head Start Association. We apologize but we are not able to take credit card payments.

Please print this page for your records.

If you have any questions about the institute, please contact Dawn Williams at email: ndhsa@ndheadstart.com or telephone (701) 237-6013.

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