Group Name:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Email:

Occupation:

Ages of Children:

Please select two classes from the list below in order of preference. If your first class is filled you will be placed in your second choice.

First Choice for Session 1:

Second Choice for Session 1:

First Choice for Session 2:

Second Choice for Session 2:

Any special needs: (ie. hearing/visually impaired or W/C user):

Method of Payment: 

Check
Paypal (Credit Card)

How did you hear about the conference?

Please read and mark the check box.  This box must be checked to complete the registration process.

I understand the resources presented in this conference are based on the training, research, personal and professional experiences of the speakers. I understand that if I have any questions regarding the appropriateness of using any of these recommendations, I will consult my physician, mental health counselor or health care provider. In addition, I understand this information is for educational purposes only and is not a substitute for medical or psychiatric care. To participate in Empowering Our Children I assume full responsibility for using these resources in a safe and effective way and release The Best You Can Be Foundation, RCB of South Florida and Temple Beth Emet from any liability which may occur at this event.

Reservations cancelled by midnight, Saturday, October 11^th will be fully refunded minus a $50 handling fee. There are no refunds following that date.  Your reservation is transferable or you may choose to receive the audiodownload of the conference.

Did you hear about the conference from your children's school?

If so, please type the name of the school

Continuing Education:

Master Plan Points Miami- Dade Teachers
Inservice Hours for Pre-School Teachers
Inservice Hours for Childcare Providers
CEU's for Nurses
None