Registration Form for Taking Action to Prevent Child Sexual Abuse: Strategies for YOUR Community

Name: _________________________________________________

Phone: _________________________________________________

Address:________________________________________________

Email: __________________________________________________

Agency or Volunteer Organization (if applicable): ____________________________________

Registration fee: By 2/28/03: $20 for individuals* ~ $40 for agencies (includes box lunch)

After 3/1/03: $25 for individuals* ~ $50 for agencies * Some scholarships are available upon request.

Please mail registration form with check made out to:

Massachusetts Citizens for Children (MCC)
14 Beacon Street, Suite 706
Boston, MA 02108

If you have questions or require special accommodations, please call 617-742-8555, extension 1. Check for conference agenda, directions and updates in the coming weeks by visiting www.masskids.org.