EVENT PRESENTER REGISTRATION

The NYS Coalition for Children’s Mental Health Services and the NYS Office of Mental Health
Children’s Mental Health Services Staff Development Training Forum

(all fields marked with an * are required)

Organization:
 *
First Name:
* Last Name: *
Title:
Address:
 *
City:
 * State: Zip *
Phone:
 - - *
Email:
 *
I am presenting on: Day 1 (Tuesday) Day 2 (Wednesday) Both (Tuesday & Wednesday) *
I will be attending the Meal: Yes No I am staying at the Hilton (Meals included) *

 

 

  
     
PO BOX 7124 ALBANY, NY 12224   PH: 518-436-8715