Focus for Life Registration Form
To register for the Focus for Life Training please fill in the information below.
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First Name
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Last Name
As you would like it to read on your certificate including middle name or initial.
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Address 1
Address 2
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City
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State
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Postal Code
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Phone
Alternate Phone
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Email Address
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Best Time to Contact
Morning
Afternoon
Evening
Which Training Location Would You Like to Attend?
February 1, 2, & 3, 2012
Helen Farabee Center
500 Broad Sreet
Wichita Falls, Texas 76301
Wichita Falls, Texas February, 2012
Dallas, TX
Mental Health America of Greater Dallas
624 N. Good-Latimer #200
Dallas, TX 75204
May 29-31, 2011
Next one in Ft Worth
Corpus Christi, TX
Location and Date TBD
Corpus Christi, TX
Amarillo, TX
Location and date to be determined
Amarillo, TX
San Antonio
Location and Date to be Determined
San Antonio, Texas
San Antonio, TX
Next one in Houston
Date and Place
To be determined
Houston, TX
Next one in Austin
Date and Place
To be determined
Austin, TX
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Where did you find out about this training?
Email advertisement
Flyer or posting
Friend or family
Newspaper advertisement
Personal inquiry
Website advertisement
Member of Recovery Focused Learning Community
Other
Comments/Additional Information
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Indicates Response Required