REGISTRATION FORM

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Florida Department of Education

HIV/AIDS Prevention Education Regional Workshops

Promoting Prevention Together

September 30, 2004, and October 7, 2004

8:00 a.m. – 4:00 p.m.

DIRECTIONS

Please complete the information form below and check the appropriate box(es)

to indicate your attendance plans. Return via e-mail by September 20, 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 print the form and FAX it to: (850) 245-5116 or SunCom 205-5116 or mail it to:

Temi Bennett, CSHP, Room 554, 325 W. Gaines St., Tallahassee, FL 32399

Pensacola, Florida

Tallahassee, Florida

HIV/AIDS Coordinator

September 30, 2004

October 7, 2004

School Health Education Coordinator

University of West Florida

Leon County Civic Center

Other School or District Professional

Conference Center

County Health Department Personnel

This is my first year in this job.

Place a checkmark in the block above the session you plan to attend.

Choose one session for the morning and one for the afternoon.

Morning Concurrent Sessions

Birds, Bees and Butterflies in Your Stomach

DOH Abstinence Project

10:15– 11:30 a.m.

10:15– 11:30 a.m.

American Red Cross – HIV/AIDS

Let’s Get STD Information into their Heads

10:15 – 11:30 a.m.

10:15 – 11:30 a.m.

Afternoon Concurrent Sessions

Birds, Bees and Butterflies in Your Stomach

DOH Abstinence Project

2:15 - 3:30 p.m.

2:15 – 3:30 p.m.

American Red Cross – HIV/AIDS Curriculum

Let’s Get STD Information into their Heads

2:15 – 3:30 p.m.

2:15 – 3:30 p.m

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Participant’s Name:

District/County:

Address:

City, State, Zip:

Telephone #:

Fax #:

E-mail address:

(Complete this form for each participant)

If you have any questions, please contact