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Pre-Registration For One Page Description Workshop 9-2-2021
Complete this form by confirming the following information by August 27, 2021. The Zoom link will be sent 48 hours before the event.
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Email
*
Your email
First and last name
*
Your answer
Phone number
*
Your answer
How will you make your payment?
*
Your Regional Center will make the payment by POS (we need an email from your Service Coordinator with the confirmation)
Through Eventbrite by credit card
Check (Payable to Parents Helping Parents with One Page Profile in memo, Send it to 1400 Parkmoor Av. Suite 100 - San Jose, Ca 95126 by August 1, 2021)
Name of your Regional Center (if you are a customer)
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Your answer
Date of Regional Center authorization by POS (purchase order)
MM
/
DD
/
YYYY
Name of your Service Coordinator
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Your answer
Payment by check - add check number here
Your answer
Date check mailed
MM
/
DD
/
YYYY
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