NIDA Town Meeting, Seattle
Registration Form
Understanding Drug Abuse and Addiction: Myths vs. Reality
Wednesday, November 10, 1999
DoubleTree Hotel Seattle Airport
Seattle, Washington

Print out, complete and mail this form by October 27, 1999, along with a check or money order for $25 made payable to Management Assistance Corporation. Space is limited, so please register early.

Send completed form with payment to:
Seattle Town Meeting c/o Management Assistance Corporation
11900 Parklawn Drive, Suite 351
Rockville, Maryland 20852
Attn: Glen Fischer

Name: _________________________________________________________
Title: _________________________________________________________
Affiliation: _________________________________________________________
Address: _________________________________________________________
Address: _________________________________________________________
City:__________________________ State:______Zip____________________
Tel:_____________________________ Fax:_____________________________
E-Mail: ____________________________________________________________

Please indicate any special assistance and/or dietary needs below:

 

For more information, contact Glen Fischer at (301) 468-6008, ext.425

Back to Town Meeting Page