1. Participant’s Name: District/County: Job Title:
      2. Address: City, State, Zip: Telephone #: Fax #: E-mail address:

REGISTRATION FORM
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Florida Department of Education
HIV/AIDS Prevention Education Regional Workshops
Promoting Prevention Together
Pensacola, February 3, 2005
Hall Center, Room 160, 30 East Texar Drive
8:00 a.m. – 3:30 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 January 21, 2005 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
HIV/AIDS Coordinator
School Health Education Coordinator
Other School or District Professional
County Health Department Personnel
This is my first year in this job.
Place a checkmark in the block above the sessions you plan to attend.
Concurrent Sessions
12:30 p.m. – 1:45 p.m.
Navigating FERPA and HIPA Requirements
Baby Think it Over
H
ow they relate to School Health Issues
The Role of the American Red Cross in
“Sex” is the question, “No” is the answer.
Prevention Education
(Best Practices)
Concurrent Sessions
2:00 p.m. – 3:15 p.m.
Navigating FERPA and HIPA Requirements
A look at the Go A.P.E.! (Abstinence Protects
How they relate to School Health Issues
Everyone) Curriculum
The Role of the American Red Cross in
“Sex” is the question, “No” is the answer.
Prevention Education
(Best Practices)
Participant’s Name:
District/County:
Job Title:
Address:
City, State, Zip:
Telephone #:
Fax #:
E-mail address:
Please call us if you need any special accommodations at this meeting.
(Complete this form for each participant)
If you have any questions, please contact
Ksena Zipperer at (850) 245-0480/SunCom 205-0480

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