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Please Mail Registration Form To:
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SUFFOLK COALITION PADD
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471 Townline Road
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Suite 101
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Hauppauge, NY 11788
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Or, FAX Registration Form To (631) 366-1785
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COMPASS COALITION TRAINING ACADEMY OF LONG ISLAND
As of
02/05/12
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Check Box
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Date
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Training
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Wednesday, February 15, 2012
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How to Conduct a School/Community Needs Assessment
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Wednesday, March 7, 2012
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Environmental Prevention Strategies
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AGENCY/SCHOOL: _______________________________________________________
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REGULAR ATTENDEE: _____________________________________________________
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MAILING ADDRESS: (Please Circle One) Home Agency/School
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STREET: _________________________________________________________________
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CITY, STATE, ZIP CODE: ___________________________________________________
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PHONE: (WORK) _______________________ (HOME) _______________________
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E-MAIL: _________________________________________________________________
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TEAM MEMBER: __________________________________________________________
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TEAM MEMBER: __________________________________________________________
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