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The Dr. Lonnie E. Mitchell National HBCU Substance Abuse Conference
April 1 - 5, 2002
Inner Harbor Marriott, Baltimore, Maryland

Registration deadline: Form must be received by March 28, 2002

General Information:

Last Name:
First Name:
M.I.:

Check at least one:
Mr.
Mrs.
Ms.
Ph.D.
M.D.
Esq.
Other
Position /Title:
Organization/Affilation:
  Home  Office
Address: 
City:
State:
Zip Code:
Country:
Daytime phone:
Fax #:
E-mail address:

Conference Pre-Registration Rates

Student $25.00
Non-student $75.00

Conference On-Site Rates (Effective April 1, 2002)

Student $30.00
Non-student $100.00

Please check the track(s) that interest(s) you most:

Prevention  Research  Treatment
Education/Training  Policy Development
Contract and Grant Writing Workshops 
Professional Certification and Licensing Workshop 
Research Capacity Building for College Students Workshop
HIV/AIDS

Special Needs

Do you have any special needs?  Yes
(e.g., dietary or Americans with Disability Act requirements) Please explain:

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The Dr. Lonnie E. Mitchell Substance Abuse Conference
For further information contact conference@cdar.howard.edu or 202-806-8600


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