Salutation		First Name*		Last Name*
E-mail*				Title*
Job Function*	...select one... Executive Mgnt. Admin. Support Multi-site Director Site Director Program Director Direct Line Staff Volunteer		Organization Name*
Site Name*			<<=== (Enter "NA " if single ste organization)
Site Address*				City*
State*				Zip Code*
Telephone*			Ext.	Website
My agency is a PASE member - Yes No DYCD Funding Source (Click all that apply): OST SYEP WIA Beacons Discretionary RHYS CSBG NYCALI BEGIN ISY OSY NDA Literacy Teen Action Immigrant Services As of January 1, 2005, PASE has initiated fees for services, with a discount for Members.

* Click the circle next to the training you would like to attend

11/7 -- (CH-FOR1) -- Responding to the Children's Health Epidemic: Using Out-of-School Time to Promote Healthy Lifestyles As space at the forum is limited, we are only able to register two staff members per program site.

* Agree to PASE Training Policies and Procedures read PASE Training Policies and Procedures
	I AGREE to PASE Training Policies and Procedures

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