recovery is for everyone! - Community Care Behavioral Health
recovery is for everyone! - Community Care Behavioral Health
recovery is for everyone! - Community Care Behavioral Health
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REGISTRATION FORM (Please reg<strong>is</strong>ter by March 22, 2013)<br />
PLEASE PRINT<br />
Recovery <strong>is</strong> <strong>for</strong> Everyone!<br />
Thursday,<br />
April 4, 2013<br />
The Marriott<br />
189 Wolf Road<br />
Albany, NY 12205<br />
Please reg<strong>is</strong>ter no later than<br />
Friday, March 22, 2013.<br />
To reg<strong>is</strong>ter, complete th<strong>is</strong><br />
<strong>for</strong>m and mail it to:<br />
<strong>Community</strong> <strong>Care</strong><br />
One Chatham Center, Suite 700<br />
112 Washington Place<br />
Pittsburgh, PA 15219<br />
Attn: Karen Neal<br />
Or e-mail it to: nealkv@ccbh.com<br />
Or fax it to: 412-454-2177<br />
If you have questions about the<br />
conference or reg<strong>is</strong>tration, contact<br />
Paul Wittman, Training Manager,<br />
at 914-226-3500<br />
or wittmanpj@ccbh.com.<br />
Th<strong>is</strong> conference <strong>is</strong><br />
offered free of charge.<br />
NAME<br />
DEGREE<br />
TITLE<br />
AGENCY<br />
ADDRESS<br />
FIRST<br />
LAST<br />
CITY STATE ZIP CODE<br />
DAY PHONE<br />
FAX<br />
E-MAIL<br />
Please indicate your lunch preference:<br />
Turkey Ham Vegetarian<br />
For Continuing Education purposes, check:<br />
NBCC Counselor Psycholog<strong>is</strong>t<br />
Social Worker Other <strong>Health</strong> <strong>Care</strong> Professional
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