Shifting the Patterns of Attachment

Friday, October 22, 2004

8:30 a.m. to 4:30 p.m.

University of Idaho, Student Union Bldg.

Silver and Gold Rooms

Moscow, Idaho

Registration Form

Date: ______________________________________________

Name: ______________________________________________________________________________________

Agency/Organization: ______________________________________________________________________

Address: ____________________________________________________________________________________

City: ______________________________________________ State: _____________ Zip: ________________

Phone Number: _____________________________________ Fax: __________________________________

Email: ________________________________________________________________

Student: Yes No (Please Circle)

· If you are a student, please include a copy of you class schedule, or a letter from you department stating you are a student.

Group: Yes No (Please Circle)

· If so, how many in your group?: __________________________

RATES:

· $45.00 if payment is received before October 1, 2004

· $55.00 if payment is received after October 1, 2004

· $20.00 student rate with proof

· 20% off all groups of five or more (not applicable with student rate).

Would you like YCFP to mail you an invoice? Yes No (Please Circle)

* Please pay by sending personal check or money order to the YCFP office at 312 S. Main, or bring cash payment.

* Make checks and money orders out to Young Children and Family Programs

* For more information, please contact Young Children and Family Programs at 208-883-6454 or 1-866-295-ycfp (9237)