NEOSSC Network Group

"Getting connected to meet the needs of those we Serve"

Conference Registration Form

                                  

                                   NEOSSC CONFERENCE Registration Form

 Program information: http://www.neosscsch.com/

Full Name: ________________________________   (Name on badge) ______________________

Organization/Agency:______________________________________________________________

Service Coordinator: ____Yes   __No      Email: __________________________________________

Mailing Address:_____________________________________________________

City: ________________________________ State: ________ Zip/Postal Code:  _________

Telephone: (______)__________________ Fax: (______)____________________

                                            

NEOSSC Member       $45.00               Nonmember   $50.00

 

REGISTRATION DEADLINE: MARCH 31, 2015

Sessions/Topics ( All Sessions are CEU Approved) 5 CEU’s for the day:

  Special Accommodations: (Please list any ADA Special Needs)

_______________________________________________________________________________

Cancellations/Changes and Refunds:  If cancellation or change resulting in a refund is received in writing prior to March 1, 2015 these refunds will be processed after the conference. Substitutions are allowed at no additional charge.

                                 Mail Complete Forms & Registration Fee to:

                                                             NEOSSC

                                                    c/o DeNeitra Brown

                                                    1588 Ansel Road 

                                                     Suite# 112

                                               Cleveland, Ohio 44106

Direct all questions to DeNeitra Brown @ (216) 744-0500