*If you need to attend both trainings, please select one date for eligibility and one date for case management; otherwise, please select the individual training you would like to attend.

*You will receive a confirmation email with locations, directions and hotel suggestions after you have registered.

*Please select atleast one date from the list below to attend.

Eligibility:

Tallahassee, August 2, 2010
Orlando - October 19, 2010
Tallahassee - November 2, 2010
None

Case Management

Tallahasse - August 3, 2010
Orlando - October 20, 2010
Tallahassee - November 3, 2010
None

Please provide the following information:

Name
Title
Organization
Street Address
Address (cont.)
City
State
Zip
Work Phone
FAX
E-mail

Please select which best represents your employment/affiliation:

Lead Agency Representative
CHD Representative
Part B Case Manager
Part A Case Manager
ADAP Worker
Other: