To registerd for POAC's 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:
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Are You A:
Have You Attended Other POAC Trainings:	Yes \| No
Are You a POAC Member:	Yes \| No
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WORKSHOP INFORMATION

Check All Workshops You Wish to Attend: $25 per class

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)

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

Workshops : Registration Form

STEP 1 : COMPLETE PROFILE