Santa Clara Valley Health & Hospital System, Department of Alcohol & Drug Services

Registration Form

1.  List each training that you wish to attend (you may duplicate this form).   One form per person.  Please print clearly
     in black ink.
2.  Fax your registration form to 408-374-3694 or mail your registration form to DADS Learning Institute, 
     595 Millich Dr., Ste. 100, Campbell, CA 95008.
3.  If applicable, make check payable to SCVHHS Dept. of Alcohol & Drug Services.
4.  For more information, call Christina Cantu at 408-374-3754.

Pre-registration is important!  Class sizes are limited and early registration may assure your place in high-demand
classes.

Organization__________________________________________________________________________________

Mailing Address/City/ZIP________________________________________________________________________

Day Phone ______________________   Fax_______________________   E-mail____________________________

DADS employee __________________   DADS contractor ____________  Other____________________________

CONTINUING EDUCATION (CE) CONTACT HOURS:  To receive CE credits and a certificate, sign in at the beginning and end of each workshop day and turn in your evaluation sheet at the end of the workshop.  Your certificate will be mailed to you within six weeks.  You must attend the entire workshop to receive credits and no partial credits will be given.  Workshop registration and CE fees are waived for DADS staff and contractors.

REMEMBER TO MARK YOUR CALENDAR WITH DATE, TIME & LOCATION.
NO CONFIRMATIONS WILL BE MAILED.