HCS/AAA Case Management and Program Training

Registration Fax Form for the week of SEPTEMBER 24-28, 2001

To: Barbara Hanneman 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 Barbara Hanneman, fax: 360-725-2646, NO LATER THAN FRIDAY, September 7, 2001