REGISTRATION FORM

R

RE

EG

GI

IS

ST

TR

RA

AT

TI

IO

ON

N F

FO

OR

RM

?

M

Florida Department of Education

Coordinated School Health Program Parent Workshop

Birds, Bees, and Butterflies in Your Stomach

September 29, 2004, and October 6, 2004

7:00 p.m. – 9:30 p.m.

DIRECTIONS

below and check the appropriate box

to indicate your attendance plans. Return via e-mail by September 24, 2004

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:

Pensacola, Florida

Tallahassee, Florida

September 29, 2004

University of West Florida

Leon County Civic Center

Participant’s Names:

Mother:

District/County:

City, State, Zip:

Telephone #:

Fax #:

Number of Children

Ages of Children

If you have any questions, please contact