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Mail To: 
Registration Services
The University of Alabama, Box 870398, Tuscaloosa, AL 35487

18th Annual Fall Social Work Conference 

The Hyatt-Wynfrey - Birmingham, AL
October 17-18, 2019

Registration Fee:

[ ] $100 - Full two-day Conference (Early-bird)     

[ ] $125 - Full two-day Conference (Registering after October 3, 2019)

[ ] $75 - One-day of Conference (Early-bird)

[ ] $125 - One-day of Conference (Registering after October 3, 2019)

[ ]Mr. [ ]Ms. [ ]Dr. First:____________________________Middle Initial:________Last:____________________________

Preferred Name/Nickname:____________________________

Company/Organization Name:____________________________

Mailing Address:____________________________City:____________________________State:________Zip:______________

Email Address:____________________________Phone:____________________________

Job Title:____________________________

[ ] Enclosed is a check for $____________________________ made payable to THE UNIVERSITY OF ALABAMA

[ ] Purchase order is attached.

[ ] Charge $____________________________to credit card: [ ] MasterCard [ ] VISA [ ] American Express [ ] Discover

Card #____________________________Exp. Date (M/Y)____________________________

Security / Verification / CVV Code____________________________(Three or four digit code on back or front of credit card.)

Authorizing Signature:____________________________

A certificate verifying attendance and contact hours will be issued to all participants.

Note: The University of Alabama is committed to complying with the Americans with Disabilities Act. Requests for accommodation of physical and/or dietary needs should be made at least 30 calendar days in advance of the program date. Please email your request to abergeron@ccs.ua.edu. A portion of the invoice amount for this program will go to the Capstone Lifelong Learning Foundation to support activities of The University of Alabama and the College of Continuing Studies. Need our STAARS Vendor Number? Please use VC000118827 for UA College of Continuing Studies.