The TRI workshop is conducted over the course of two days from 9AM to 3PM on both days. Twelve CEUs will be awarded upon completion of the workshop. Please complete the following form by typing or printing in black ink.

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NAME: _____________________________________________________

ADDRESS: __________________________________________________

CITY: ______________________________________________________

STATE: _____________________________ZIP: ____________________

PHONE: ____________________________FAX: ___________________

EMAIL: ________________________

PROFESSION (LICENSURE TRAINING): __________________________

TOPICS OF INTEREST:_________________________________________

DATE OF WORKSHOP:________________________________________

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Please mail this form (along with check written to Touch Research Institute) to:

   Touch Research Institute (D-820)

Department of Pediatrics

P.O. Box 016820

Miami, FL 33101

If you have any questions please call us at (305) 243-6781.