Planned Parenthood Education Presentation

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Planned Parenthood Hudson Peconic, Inc.
Tuesday, March 19 at 7:00 PM
Putnam Independent Living Services, 1441 Route 22, Suite 204, Brewster, NY 10509

Please register by answering all questions, then click "submit" at end of form. This information is needed for our funding sources, and is not used to discriminate during the application process. This information allows us to continue to provide free informational programs to the community. Thank you!

First Name *

Last Name *

Email Address *

Re-type Email Address *

Phone/Cell Number *

Are you attending this workshop as a parent or a professional? *

If both a parent (of a child with suspected disability, 504 Plan, or IEP) and a professional in the field, please complete application in the role of parent by choosing parent.

Parent

Professional

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