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