Join the Coalition for Safe Communities, along with local social service, health care, & prevention agencies, for a Family Relationships Forum.
 
Goal: To strengthen families in our community by addressing social, emotional and health needs.
 
Event Details:
When: Saturday, September 30, 2017
Time: 10am-2pm, Light breakfast & lunch Included (Set up after 8am)
Where: Absegami High School, 201 S. Wrangleboro Rd., Galloway, NJ
 
Find out more information about the Coalition for Safe Communities and past events at: http://www.cscatlantic.org.
 
Please complete the form below to reserve your space at this event.
FORMS MUST BE SUBMITTED BY SEPTEMBER 15th FOR YOUR AGENCY TO PARTICIPATE.
DATE TO SUBMIT REGISTRATION EXTENDED TO 2pm Tuesday, SEPTEMBER 26th.  This is the last date to register for the event to be included in the program.
 

Name:

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* 1. Name:

I will be attending the Family Relations Event on September 30, 2017.

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* 2. I will be attending the Family Relations Event on September 30, 2017.

Email Address:

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* 3. Email Address:

Agency Representing:

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* 4. Agency Representing:

Agency Address:

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* 5. Agency Address:

Agency Phone Number:

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* 6. Agency Phone Number:

Agency Email:

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* 7. Agency Email:

Agency URL:

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* 8. Agency URL:

Brief Description of Agency: (Limit 250 words)

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* 9. Brief Description of Agency: (Limit 250 words)

Set Up Needs for Information/Agency Tables:

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* 10. Set Up Needs for Information/Agency Tables:

Break out sessions throughout the day will feature community agencies presenting on topics fitting within the categories below. If you are interested in being a presenting agency please provide a title, brief description, and select the best category which your presentation will focus on. If you would like more information regarding the breakout sessions, please contact Dewane Parker: dewaneparker@yahoo.com

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* 11. Break out sessions throughout the day will feature community agencies presenting on topics fitting within the categories below. If you are interested in being a presenting agency please provide a title, brief description, and select the best category which your presentation will focus on. If you would like more information regarding the breakout sessions, please contact Dewane Parker: dewaneparker@yahoo.com

Break Out Session Best Fits in Which Category:

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* 12. Break Out Session Best Fits in Which Category:

Presentation Title:

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* 13. Presentation Title:

Presentation Description:

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* 14. Presentation Description:

Break Out Room Presenter Needs:

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* 15. Break Out Room Presenter Needs:

Presentation Title #2:

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* 16. Presentation Title #2:

Break Out Room Presenter Needs #2:

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* 17. Break Out Room Presenter Needs #2:

The agency I represent focuses on addressing:

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* 18. The agency I represent focuses on addressing:

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