Register

Join us for our National Conference, April 8 through 11, 2003 in Tucson, AZ. REGISTER HERE

2003 Conference Registration Form

PRINT OUT FORM, COMPLETE AND RETURN WITH PAYMENT TO:

Don Haskell – NCCDA Chair

Casa de los Niños, 1101 N 4^th Ave, Tucson, AZ 85705

BY MARCH 1st, 2003 FOR EARLY BIRD SPECIAL

or by March 28, 2003

Name

□ I will be attending the Pre-Conference on April 8th.

Address

City ST Zip

Agency Name

Title

Daytime Phone ( )

Fax Number ( )

E-mail Address

Registration TOTALS

First attendee $350 ($300 if paid by March 1, 2003)

Additional Attendees $250 each

Guests for Evening Out Activity $50 each ____________

Grand Total

checks payable to NCCDA

Additional Attendees

Name Title

□ will be attending the Pre-Conference on April 8th.

Name Title

□ will be attending the Pre-Conference on April 8th.

Name Title

□ will be attending the Pre-Conference on April 8th.