TRAINING DATES

Dates	Location	Region	Application Deadline
April 12-15, 2011	Atlanta, GA	Southern	March 29, 2011

  Download the brochure here, fill it out, and fax to (212) 629-3321 or email it to cornell@cicatelli.org

Upon receipt and review of your application, CAI project staff will contact you to discuss your application and the selection process.

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Pre-Registration Form

HRSA Consumer-Provider Partnership for Care
Youth Transitioning Training

April 12-15, 2011 — Atlanta, GA

(To be completed by authorized supervisor or executive director)

*= Required

* Your Name:
* Position:
* Agency:
* Address:
* City:	*State: *Zip Code:
* Email:
What Type of Ryan White Care Act Funds does your agency receive?
* Title:	A. B. C. D.   * Contract #:
Names of the Young Adults (Consumers) you plan on sending to this Program:
* 1:
2:
Name(s) of the Clinical Care Staff (Providers) who will attend this program:
* 1:
2:

Please note that seating is limited and registration is not complete or guaranteed until you receive a confirmation email from the program associate.

Cicatelli Associates Incorporated, 505 Eighth Avenue, Suite 1600, New York, NY  10018
phone: (212) 594-7741 / fax: (212) 629-3321
http://www.cicatelli.org

© Copyright 2011, Cicatelli Associates Inc.