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March 17 -18, 2011 Student Union University of

Nevada, Las Vegas

REGISTRATION FORM You are invited to join Family TIES of Nevada for a unique training opportunity for youth with special health care needs and disabilities, family members and professionals who serve them. Learn about the transition process and how health influences success in school, work and independent living. Fees (Breakfast/Lunch included) $75 Professionals $40 Youth and Family Members 

How to Register

Mail or Fax Form and payment to: Family TIES of Nevada  A limited number of scholarships available for youth and family 3100 members Mill Street #117 Reno, NV 89502 Call 1-866-326-8437 for details Fax: 775-323-2205 Register & make secured online payment at: http://familytiesnv.org/training/registration_form Call 1-866-326-8437 for direct assistance.

Payment Method (Check one) Please consider me for a scholarship Purchase Order #       Check (payable to Family TIES of Nevada)

 Complete one form for each attendee  Participant Information Full Name:      

Professional:

Youth/Family Member:

Company/Title (If applicable):       Address:       CANCELLATION POLICY Substitutions may be made any time prior to the event. Cancellations received by email, fax or phone after March 10, 2011 are subject to an administration fee equal to 50% of the registration fee. No shows are non-refundable.


City:      

State:      

Home Phone:       Special Dietary Needs:

Zip Code:      

Work Phone       Vegetarian

Cell Phone:      

Email:      

Diabetic

Hotels Embassy Suites Hotel *** 4315 Swenson Street Las Vegas, NV 89119 (866) 813-5349

Comfort Inn Las Vegas ** 4350 Paradise Road Las Vegas, NV 89169" (702) 938-2000

Holiday Inn Las Vegas *** 4055 Palos Verdes Street Las Vegas, NV 89119 (702) 473-6400

Hyatt Place Las Vegas *** 4520 Paradise Road Las Vegas, NV 89109 (702) 369-3366

Hard Rock Hotel **** 4455 Paradise Road Las Vegas, NV 89109 (800) 473-7625

Terribles Hotel and Casino ** 4100 Paradise Road Las Vegas, NV 89109 (702) 733-7000

CANCELLATION POLICY Substitutions may be made any time prior to the event. Cancellations received by email, fax or phone after March 10, 2011 are subject to an administration fee equal to 50% of the registration fee. No shows are non-refundable.

Jamboree, registration  

Jamboree, registration

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