Registration Please indicate the quantity you would like for each type of registration shown below. Then click on "Continue" to confirm your order selections and total. After that we will ask for your name and address information and your payment information to complete your order on our secure server.   Late Registration $300 after December 14, 2012   Order at $300.00 each Price: $300.00 Processing: $0.00 Total: $300.00

Activity Questionnaire Center for Social Innovation has requested that its customers provide the following information to better help it fulfill your order. Required questions must be answered in order to complete your order.    First Name **Required      Last Name **Required      Email Address **Required      Phone Number        Organization Name **Required      Street Address **Required      City **Required      State **Required      Zip Code **Required      What is your role? **Required ConsumerDirect Service Provider (Clinician/ Case Manager/ Outreach Worker/ etc)Administrator/ Program Director/ ManagerEducator/ Teacher/ TrainerAdvocateNone of the above Hold down the "Ctrl" key to select multiple responses.  What area do you work in? **Required EducationEmploymentHousing or ShelterHealth or MedicalMental HealthStreet OutreachSubstance Use/ AddictionsLaw EnforcementNone of the above Hold down the "Ctrl" key to select multiple responses.  How did you hear about this training? **Required t3 emailt3 e-Newsletter (What's the Buzz @t3)t3 Facebook paget3 Twitter linkt3 table at a conferenceCenter for Social Innovation/ t3 staffThe National Center on Family HomelessnessColleague, supervisor, or friend Hold down the "Ctrl" key to select multiple responses.  Are there any other places where you heard about this training?        Why are you attending this training? **Required Relevant topicsTrainersLocationSupervisor requestColleagues or friends are attendingCEUsNone of the above Hold down the "Ctrl" key to select multiple responses.  Are you interested in any follow-up activities? **Required Online training modules on related topicsTargeted technical assistance in your regionOnline discussion forums with other training participantsWritten resources/ materialsNone Hold down the "Ctrl" key to select multiple responses.  What other follow-up activities or resources are you interested in?        Are you interested in receiving announcements about future training opportunities? **Required YesNoPossibly

Center for Social Innovation Purchase/refund policy: The Center for Social Innovation offers both free and fee-based training events. For fee-based trainings, agencies that pay in full can request a refund until two weeks prior to the date of the training. Refunds will not be provided if requested after this time. Refunds for free trainings are not applicable. Acteva's Purchase/refund policy: Refunds and cancellations are provided only at the discretion of the organization hosting or sponsoring this event. Acteva issues credits only when directed to do so by the sponsoring organization. Contact refunds@acteva.com or the sponsoring organization for further details.