LA County Department of Public Health - CONFERENCE REGISTRATION FORM

Updates on national efforts in the U.S. to reduce sodium intake

LOCATION: Childrens Bureau, Magnolia Conference Center
1910 Magnolia Avenue Los Angeles, CA 90007
(free parking)
CONTACT: Michael Todd Greene, RD At (213-351-7335) Or migreene@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:

* Select the session(s) listed below as (1-2-3-4 etc.), according to the session you prefer to attend:
General Session: September 30 2009 8:30A.M. - 12:00P.M.

* 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.