Please fill out the form below with your work contact information and click "Submit" when you are finished.

Bold fields are required!
First Name:
Last Name:
Work Email Address:
Agency:
If Other is selected (please specify):
Job Title:
Work Address:
Street:
City:
Zip Code:
Phone Number: Format: 444-444-4444
Fax: Format: 444-444-4444
 
Please select only one conference date and location from the following list:
            
LocationDate
Decatur October 2, 2007
Gainesville October 3, 2007
Macon October 19, 2007
Savannah October 18, 2007

Cancellation

Due to the demand to attend the conference and limited space at each site, we will maintain a waiting list. If you have registered for the conference and are unable to attend for any reason please contact Laurel Beckham (Center for Child Well-Being) at 404-592-1435 or lbeckham@taskforce.org as soon as possible. This will allow us to fill your space with someone else on the waiting list. Thank you for your cooperation.

Help

For training session information, contact Laurel Beckham at 404-592-1435 or email lbeckham@taskforce.org.