Online Registration Form for the ADDA-SR Workshop

Successfully Managing

Strong Willed and Defiant Children and Teens


Fill out the information below completely. Then click on the register button and you will be registered for the conference.


Registration information

 

 

                      Last Name:  First Name:                   
                 Street Address:
                               City:
                           County: 
                             State:
                        Zip Code:
                      Telephone:
                           E-mail:
      Credentials/Profession:

How did you hear about the workshop?

I would like to become a member. Please include $40 for my membership dues.   Please send my newsletter via e-mail.   
Registration cost  

Price

Individual Registration   $40.00
2 Family members  $75.00
Membership
Renewal 
New Member  
I am already a member but do not need to renew my membership at this time.
  $40.00
Thank you for  all your work.  I would like to make a donation of    

Total Amount

   

Payment Method:


Master Card**

Discover**

Visa **

American Express **

PO #        

**Print Name on Card:  
** Account Number:  
** Billing Address:  
** Expiration Date:  

School purchase orders will be accepted.

Please include individual registration forms.

Registration must be received in office by Wednesday, November 12, 2008.

Add $5 for Walk-in
Registration.

I need a certificate of attendance.

Form Submission


 

 

 
This page designed by Opal Harris.
Copyright © 1995 [ADDA-SR]. All rights reserved.
Revised: October 06, 2008.