Training Entry Form

		TOT Registration Form Print and complete the form below to register for the 2009 Michigan Model for Health^® Training of Trainers. The training is limited to twenty five participants. Please mail or fax this registration form to: Educational Materials Center (EMC) 139 Combined Services Building, CMU Mt. Pleasant, MI 48859 FAX: 989-774-3943
return to TOT page	Registration Deadline Extended to June 15, 2009

____	I want to register for the August 10-14 Training of Trainers for Grades 7-12
____	Enclosed is my payment/purchase order for $___________. ($950* per participant)
____	Payment or a purchase order will be mailed. I understand that my registration is not confirmed until payment is received by the EMC.
	Name:__________________________________________ School/Organization: _______________________________ Address: ________________________________________ City/State/Zip: ____________________________________ Telephone: ( ) _________________________________ FAX: ( ) ______________________________________ e-mail address: ___________________________________ Telephone number during summer months: ( ) ____________________________ Special Diet requirements __________________________ (i.e. vegetarian, food allergies, etc.)

*Registration fee includes training, training materials, trainer's toolkit on CD, lunch and snack each day of training. Individuals are responsible for all other meals, lodging and travel.