Choose a training date/location:

	September 16 , 2008 Northampton 5.5 CEUs
	September 23 , 2008 Brockton 5.5 CEUs
	September 30 , 2008 Boston 5.5 CEUs
	October 15 , 2008 Worcester 5.5 CEUs
	October 21, 2008 Tewksbury 5.5 CEUs
	October 28, 2008 Canton 5.5 CEUs

Contact Information:

first name:
last name:
Program/Agency:
address:
city:
	select a state none Alabama Alaska American Samoa Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
zip:
phone:	ext.
fax:
email:
retype your email:
Are you the PAC?	yes no
Will you want CEUs?	Social Worker Nurse CADAC LMHC
Are you a BSAS provider?	yes no
Please name your BSAS Contract Manager:

• Pre-registration is required. Lunch and food will not be provided.
• Space is limited; registration is on a first-come, first-serve basis. Register early!
• Directions will be e-mailed to you with confirmation.
  

Questions?
Helen Edwards
SPHERE Training Specialist
SPHERE
942 West Chestnut Street
Brockton, MA 02301
Phone: (508) 583 2250 x228
Fax: (508) 583-2611
Email: hedwards@hcsm.org

For more information about Health Care of Southeastern Mass and other services provided by the agency, please visit Prevention & Community Services.