METH DOES NOT
Transcription
METH DOES NOT
METH DOES NOT DISCRIMINATE FreE EvenT / OpeN TO PubliC SEPTEMBER 21, 2010 8:00 am - 4:30 pm Moenkopi Legacy Inn • Tuba City, AZ METH DOES NOT DISCRIMINATE September 21 2010 • Moenkopi Legacy Inn • Tuba City, AZ REGISTRATION FORM Date: __________________________ First Name: ___________________________________ Last Name: ___________________________________ Job Title: ___________________________________ Organization: ___________________________________ Mailing Address: ____________________________________________________________________________ City: _______________________________________ State: ____________________ Zip: ________________ Phone: ______________________________________ Email: ________________________________________ Gender: (Check One) ❑ Male ❑ Female Age: ❑ 9-24 ❑ 25 - 34 ❑ 35 and older Community you reside in: ______________________________________________________________________ How did you find out about this training: ❑ Received telephone call/message. ❑ Received an e-mail. ❑ Other ______________________ Are you interested in being involved in other Meth and/or Suicide Prevention Activities? ❑ Yes ❑ No ❑ I can’t commit just now, but keep me informed. Return completed form to: Tuba City Suicide Prevention Task Force Mental Health Department P.O. Box 600 Tuba City, AZ 86045 REGISTRATION DEADLINE Wednesday, September 17, 2010 Fax to 928-283-2832 or email to Ruth.Begay@tchealth.org OR Fax to Lavina Begay-Nez at 928-283-3039. Certificates of attendance will be provided to participants. Please register as soon as possible for there are a limited number of seats. For more information, call Ruth at 928-283-2831 or Lavina at 928-283-3346. METH DOES NOT DISCRIMINATE September 21 2010 • Moenkopi Legacy Inn • Tuba City, AZ HOTELS AND RESTAURANTS HOTELS RESTAURANTS • Moenkopi Legacy Inn & Suites U.S. 160 and Road 260 Tuba City, AZ 86045 Phone: (928) 283-4500 • Hogan Restaurant • Subway • Golden Rice Bowl • Quality Inn 10 North Main Street Tuba City, AZ 86045 Phone: (928) 283-4545 • Diné Inn Motel U.S. 160 & Peshlakai Ave. Tuba City, AZ 86045 Phone: (928) 283-6107 • Bashas’ Deli • Kate’s Café • Taco Bell • McDonald’s • Sonic Drive-In • Greyhills Inn U.S. 160 & Warrior Dr. Tuba City, AZ 86045 Phone: (928) 283-4450 • Tuuvi Café