Registration

To register for one of our upcoming trainings/conferences, please select which of the following you would like to attend along with the date (if known), enter your contact information and submit the form.

Please send payment, as indicated, immediately after registering. You will receive a call or email to confirm your registration as soon as payment is received in our office. Please send payment to: Regional Prevention Center, 1125 West Spruce, Olathe, KS 66061.

Johnson County STOP Golf Tournament
Loch Lloyd Country Club

Tuesday, October 28, 2008
Early Bird registration - before 10/17 - $95 per person, $380 per team
After 10/17 must register by phone to 913-715-7880 $97.50 per person, $390 per team

Registration Form *required info
*Select Training/Conference:	Golf Tournament MAAP Conference - $25 TIPS Off-Premise - $40 TIPS On-Premise - $40 KS Tobacco Retailer Training - $40 Tobacco Free Teens -$80 Baseline Training - $45
Date of Training/Conference:
*Contact Name:
Title:
*Email address:
*Phone: Example:(913) 715-7880
Home Phone:
Agency/Company Name: (if applicable)
Street Address:
City:
State:
Zip:
Participants Names : (if applicable)
Comments:
Your registration is not confirmed until you receive confirmation.
Security test. Please identify these pictures to verify your request: Click to identify Apple Cat Clock Dog Flower Fork Hammer Key Ship Tree Click to identify Apple Cat Clock Dog Flower Fork Hammer Key Ship Tree Click to identify Apple Cat Clock Dog Flower Fork Hammer Key Ship Tree