HCS/AAA Case Management and Program Training

 

Registration Fax Form for the week of March 12-16, 2001

 

To:              Carol Sloan, Home & Community Services, Fax:  360-725-2646

                                                                                               

From:          Name___________________________________________Phone___________________________

 

Fax____________________________________Region/PSA:______________________________

 

Date:           _______________________________                  # of Pages_________________________

 

Instructions for aaa and hcs social services staff:

 

Please list ONE nominated staff person (N) and THREE alternates (A) to contact in case the first one cannot attend. 

 

Check

N	A	Name (print)	Title	Office Address	Phone	Fax	Supervisor’s Name

 

Instructions for hcs financial staff:

 

Please list TWO nominated staff persons (N) and THREE alternates (A) to contact in case the first one cannot attend. 

 

Check

N	A	Name (spell)	Title	Office Address	Phone	Fax	Supervisor’s Name

 

Please fax this form to Carol Sloan, fax:  360-725-2646, NO LATER THAN FRIDAY,