Registration for Pines Education Institute of S.W. Florida
 

Date:  (mm/dd/yyyy)

If you are registering for yourself and another person, type both attendee names

Name(s):   

Organization:

Title:

Street:

City:

State:    Zip:

Email:

Phone:

Fax (if we need to fax W-9 to you):

Current Programs To Register:

Core Training July 21-25, 2008 - sign up with Tom Campbell (727) 341-4772

Teepa Snow's "ABC’s Of Dementia And Care Giving – The Essentials For Good Care" PLUS "Caregiver Skill Building And Problem Solving" July 26, 2008  $45 includes lunch

If you are registering for yourself and another person, list the program for each person.

Copy/Paste or Type in Program(s) Registering for:

Total Amount Due:

Paying by Check (indicate if you need W-9 faxed to you): 

Paying by telephone Master Card or Visa or Discover: 

Click "Submit" button at bottom of page.  An immediate response should show your registration. 

If you selected Check or Money Order make it payable to "Pines of Sarasota".

Mail to: Pines of Sarasota   Attn:JoAnn Westbrook    1501 N. Orange Avenue     Sarasota, Florida 34236

Your registration is confirmed when payment is received.

 

If you selected to Phone in your Credit Card, our Pines Billing Associate will contact you shortly for payment.

Your registration is confirmed when payment is processed.

Thank you. All registrations are non-refundable.

JoAnn Westbrook—Director of Pines Education Institute of S.W. Florida   941-365-0250 x 1114