Florida School Health Association St. Augustine Florida FSHA

Florida School Health Association St. Johns County

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	The Crossroads of Healthy Schools and Successful Learners May 13th and 14th, 2010 Embassy Suites, Orlando-North

Florida School Health Association

2010 Annual Conference
Conference Registration Form

Print your name as you would like it to appear on your badge.

Your contact information:Please complete all areas

First name:

Last Name:

Title:

Organization:

Contact Address:

City: State:

Zip:

Contact Telephone:

Fax number:

Preferred Email:

Payment Information

Registration fee - $99.00 per person

*Registration fee includes one-year membership in Florida School Health Association and an Awards Luncheon.

Select Payment Method:

I am paying by credit card using PayPal.
To pay by credit card or account debit using PayPal, check above, submit your application and you will be presented with the PayPal payment option.

I will print this form for completion and pay by check or purchase order.
To pay by check or purchase order mail your payment or purchase order and a copy of this form to:

FSHA Conference Registration
64 Raintree Circle
Palm Coast, FL 32164

For additional information or if any special needs are required, please contact Leslie Shugart at bradingleslie@bellsouth.net

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