REGISTRATION FORM

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Association

in collaboration with

Florida Department of Education

Health Promoting Schools Orientation

July 22, 2004

9:30 a.m. to 2:00 p.m.

DIRECTIONS

Complete the information below. Return via e-mail by July 8, 2004 to:

CSHPRegistration@fldoe.org

(STEP 1-Complete the form, STEP 2-Click File, then click on Send To,

STEP 3-Type in the e-mail address listed above, STEP 4-Click Send)

or complete form below, print the form and FAX it to: (850) 245-5116, or mail it to:

Temi Bennett, CSHP-FEC 554, 325 W. Gaines Street, Tallahassee, Florida 32399

District/County:

Participant Name:

Job Title:

Address:

City, State, Zip:

Telephone #:

Fax #:

E-mail address:

(Complete this form for each participant)