Event Registration | Family Voices of California

Registration for 2012 Health Summit hosted by Family Voices of California

March 13 - 14, 2012
Sacramento
For More Information, Click here

First Name:
Last Name:
Organization (if any):
Phone:
Address:
City:
State:
Zip Code:
Email Address:
Please indicate the category that best describes you:
Other Category:
are you associated with one of the FVCA Family Resource Centers?
Specify FRC if other:
Accomodations: Please indicate if you have special needs and require accommodations to participate.
Interpretation?
Language:
Sign Language?
Will you or your family member need wheelchair-accessible transportation and/or lodging to attend the Summit?
Comment:
Other accommodations (please specify):
If you are a parent or youth, would you like information on how to apply for a scholarship to help cover travel?
Are you a professional or nursing student seeking CEUs?
There is a $10 fee associated with CEUs that can be paid by cash, check or online.
We will have a break room for children with limited adult supervision. Personal care not included, but some activities and snacks. Supervisors will get parents if needed by child. If you are planning on bringing your children to the event, please provide their names, ages and any additional information necessary:

Arrangements cannot be guaranteed until receipt of separate confirmation for registration, scholarships and/or childcare. Please expect separate confirmations for each to the email address you have provided.