Teen Center Registration

Thank you for your interest in Teen Center’s Annual Conference 2008: A Law Enforcement Symposium. This conference is supported by the Office on Violence Against Women (OVW) for law enforcement officials.

Please complete the registration form below and your attendance will be confirmed by Break the Cycle within 48 hours. If you have questions about this registration form, please contact us at teencenter@breakthecycle.org.

Law Enforcement Officials Register Here

Your Work

Are you a law enforcement official?
Do you work with teens experiencing dating violence?
Do you work with an under-served population?
If so, please specify:

Conference Logistics

How many nights will you require accommodations at Carlyle Suites?
Do you have any dietary restrictions?
Do you require any special accommodations for the conference?

Prefix

Last Name

First Name

Job Title

Agency

Address

City

State

Zip

Phone

Fax

Email

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