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ADLS™ Instructor Course Registration Form

Use this form to register for the ADLS Instructor course offered on Wednesday, Sept. 24, at the MACIE Training Center, 1615 Springfield St., Dayton, OH 45403. The cost is $150. For more information, please call 937-775-1320 or e-mail Julia Smith.

First Name:
Last Name:
Profession/Status:
Employer/School:
Employer/School Address:
Employer/School City:
Employer/School State:
Employer/School Zip:
Home Address:
Home City:
Home State:
Home Zip:
E-mail:
Home Phone:
Work Phone:
Comments:
   
Thank You!

For NDLS and AHA Course information, contact:
Dan Kirkpatrick, R.N., M.S.N.
Assistant Director, Workforce Development
(937) 775-1320
Fax: (937) 775-1329
daniel.kirkpatrick@wright.edu

Last updated 8/4/08 (rjs). For more information, contact the HELP Center.