Kaleidoscope - Registration

Virginia Commonwealth University
Partnership for People with Disabilities

Kaleidoscope Level I

New Perspectives in Service Coordination

Enter information here to register an individual for the conference and click the "Add" button.
Once your registration is received, a confirmation letter with directions will be mailed out to you. Please contact Cori Hill at (540) 943-6776 corihill@ntelos.net with any questions.

Name

Agency Name

Street Address (Home)

City (Home)

State (Home)

Zip Code (Home)

Phone (Home)

Special Accommodations and
Date of Successful Completion of Level I

Vegetarian Diet?

Yes No

Date and Location

Please select the date and location you wish to attend

Select	Date	Location
	April 30, 2007 (10:00am-5:00pm) and May 1, 2007 (8:30am-4:30pm)	Renaissance Portsmouth Hotel, Portsmouth, VA

Note: for an address to be valid you must enter data for street address, city, state, and zip code.

The cost per person is $50.00

Register all individuals by entering their information and clicking the "Add" button before you proceed to the checkout.
You have registered 0 people so far for a total cost of $0.00

Virginia Commonwealth University Partnership for People with Disabilities Kaleidoscope Level INew Perspectives in Service Coordination

Virginia Commonwealth University
Partnership for People with Disabilities

Kaleidoscope Level I

New Perspectives in Service Coordination