PART I. Contact Information

Instructions: Registration has now opened for the Annual Strengthening Youth & Families Conference. Review all of the information about the conference by going to http://www.cvent.com/d/q5qf3c/4W.  There are limited scholarship funds available to assist individuals in attending the Conference in Georgetown, Texas. Please provide the detailed information below by August 30, 2017. If you have any questions, please call Glen Hilton at 832.276.5376.

* 1. Name:

* 2. Street Address:

* 3. City:

* 4. State:

* 5. ZIP Code:

* 6. Primary Phone # (use format ###-###-####):

* 7. Primary Phone # Extension:

* 8. Secondary Phone #:

* 9. E-mail:

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