Mid-Missouri Chapter - Alzheimer's Association



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Memories in the Making®

Facilitator Training

Thursday, September 26, 2013

10 am to noon (Registration at 9:45 am)

Alzheimer’s Association - North Central Texas Chapter

2630 West Freeway, Suite 100, Fort Worth, Texas 76102

Registration Form

Return registration form and payment to Alzheimer's Association

2630 West Freeway, Suite 100, Ft. Worth, TX 76102

Checks, VISA, MasterCard, American Express, and Discover accepted

FAX 817-336-4966

Phone: 817-336-4949

Please check one:

I intend to volunteer for Memories in the Making (no charge)

I am staff at a community that already hosts Memories in the Making (no charge)

My employer does not host Memories in the Making but I would like to earn

Two hours NCCAP continuing education for activity professionals ($25 charge)

Participant

Title

Organization

Address

City_____________________________ Zip ___________________________________

Telephone email

Payment

Check or cash enclosed

Credit Card #

Exp. Date

Name on credit card________________________________________________________ Signature

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