South Region GREAT Center 700 University Blvd., MSC 147 Kingsville, Texas 78363-8202 (361) 593-4183 Fax (361) 593-4263

Registration Form
South Region GREAT Center

Please complete a registration form for each person who will be attending workshop(s) from your program. Duplicate this form as needed and return by fax to (361) 593-4263.

Name: ___________________________________________

Program: _________________________________________

Mailing Address: __________________________________

City:________________ Zip: ____________

Phone Number: _____________ Fax: ________________

Email: _______________________________

Workshop Information

Workshop Topic: __________________________________

Workshop Date(s): ________________________________

Workshop Time(s): ________________________________

Location (City): ___________________________________

Additional Information

For information on current training descriptions (i.e. name of training, times, etc.) visit the South Region GREAT Center Calendar and click on Additional Information.

Contact the South Region GREAT Center at (361) 593-4183.