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Rally For Awareness Registration Form


 

8th Annual Rally for Awareness
Registration Form



Registration Deadline is April 17, 2011


Rally for Awareness

April 28, 2011 - Thursday

8:00 a.m. – 1:45 p.m.
Registration: 8:00a.m. - 9:00 a.m.

Rally for Awareness Agenda

Location: Shocco Springs Conference Center in Talladega, AL
     Directions
     Map


Please e-mail a list of students' names, grades and t-shirt sizes to April Smith (asmith@thefocusprogram.com) as soon as possible to guarantee t-shirt sizes. If forms are submitted at registration on the day of the Rally, then t-shirt sizes are not guaranteed. Also, if your school requires students to sign a photo release form please bring it to the event.

There is a limit of 20 students per school.

Registration Deadline is April 17, 2011


-Professional Development for educators will be provided by Jacksonville State University Regional Education In-Service Center.
-Continuing Education hours (4) are approved for Social Workers by the Alabama Board of Social Work.

There is a $10.00 per person (including bus driver) registration fee (covers lunch and materials). Invoice for payment will be e-mailed upon receipt of your registration form. NO CASH PLEASE! SCHOOL CHECK or Purchase Order Number. PAYMENT DUE PRIOR TO THE RALLY.

Make the check or Purchase Order payable to:
     Family Links/FOCUS Program
     c/o Sue Jones
     2297 Bellevue Court
     Hoover, AL 35226


For registration information, please contact:

April Smith, Communications & Events Coordinator
FOCUS Program
asmith@thefocusprogram.com  


For program information, please contact:

Sue Jones, Executive Director
FOCUS Program
(256) 453-4245 or sjones@thefocusprogram.com 
 


                             

Name of School:
Address:
City:
Zip:
County:
Chaperone #1 Name (First & Last):
Chaperone #1 Position:
Chaperone #1 Day Phone:
Chaperone #1 Evening Phone:
Chaperone #1 Email:
Chaperone #2 Name (First & Last):
Chaperone #2 Position:
Bus Driver Name:
Number of Students Attending:
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