Parents of Autistic Children POAC

Making a Difference... Now!                   Phone 732-785-1099

Free Workshops : Registration Form

To registerd for POAC's Free Workshops, please complete the form below. All fields are required unless otherwise noted. Information collected is and will be used for Grant writing purposes and data collection ONLY. POAC never sells or distributes any information gathered on this or any of its web sites.

ATTENDEE INFORMATION

* First Name:
* Last Name:
* Address 1:
Address 2 (Optional):
* City:
* State/Province:
* Zip/Postal Code:
* County:
* Phone:
Fax (Optional):
* E-mail:

* Are You A:

* Have You Attended Other POAC Trainings:
Yes | No
* Are You a POAC Member:
Yes | No

* Ethnicity:


WORKSHOP INFORMATION

* Check All Workshops You Wish to Attend:
Empowering Parents to Solve Problem Behaviors at Home Part 1 (Sewaren, NJ)
Empowering Parents to Solve Problem Behaviors at Home Part 2 (Sewaren, NJ)
Introduction to Verbal Behavior One Day 2/27/09 Chilton Memorial Hospital, Pompton Plains
Overview of Estate Planning and Guardianship 12/03/08 (POAC Center Brick, NJ)