LA County Department of Public Health - CONFERENCE REGISTRATION FORM

This workshop will provide information for service providers about upcoming changes in health care coverage due to the Affordable Care Act (ACA) and the impact it will have on adolescents and young adults access to health care services. This training is designed to prepare providers to be proactive and guide youth to navigate these changes, address challenges and avoid gaps in coverage.

LOCATION: Children's Hospital Los Angeles-Saban Auditorium
4661 Sunset Blvd. Los Angeles, CA 90027
CONTACT: Sandra J. Guine, LCSW, ACSW At (213-639-6443) Or sguine@ph.lacounty.gov

Participant Information
* First name:
* Last name:
* Position Title:
* Work Organization:
* Street1:
Street2:
* City:	State: Zip:

* Phone:	Fax: (e.g.999-999-9999)
* Email:
* Immediate Supervisor's Name:

* Please select 1 next to the class that you would like to attend
The Impact of the Affordable Care Act : Thursday, October 3, 2013 8:30 AM-12:00 PM

* I have received my supervisor's approval to attend the marked session(s):
* I am available to attend any of the sessions I have marked above.