Temporary Loving Care


Registration

                             

                               Registration Form


             Please provide the following information:



First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Phone #:

E-mail:

Organization:

I will be attending       One Day      Both Days

Additional Participant:         One Day         Both Days

Additional Participant:         One Day         Both Days

Additional Participant:         One Day         Both Days

Additional Participant:         One Day         Both Days
The cost of this conference is $25 per day per person


Please Fill out the registration form, print the form,
and mail with your registration fee to:

The Landing Place
1201 W.N. Carrier Parkway Suite 101
Grand Prairie, Texas  75050


Remember that we only provide lunch for those who pre-register

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