Location: UVA School of Continuing and Professional Studies,
Zehmer Hall, 104 Midmont Lane, Charlottesville, VA 22904
Course Fee: $75 per person
NAME: ________________________
ADDRESS: _______________________________
PHONE: _________________________________
E-MAIL : __________________
________________________________________
AGENCY:
__________________________________________
Complete and mail this registration form along with a check payable to:
Virginia Child & Family Attachment Center, 1001 E. Market St., Suite 201, Charlottesville, VA 22902
Or fax the form to: 434-328-2953
