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Registration Form <br />2000 Human Services Advisory Commission Forum <br />September 13, 2000 <br />The William & Ida Friday Center <br />Registration for the HSAC Forum is $10.00 per person. <br />Make checks payable to the Orange County Manager's Office. Return this form with your <br />check, no later than August 25, 2000, in the enclosed stamped self - addressed envelope. <br />0 Enclosed is a check for $10.00 to cover registration and lunch for the following person. <br />NAME: <br />AGENCY: <br />ADDRESS: <br />TELEPHONE: <br />Note: Please use ONE FORMper person; you may make photocopies of the form. <br />Please prioritize areas of interest for improving mental health service delivery <br />in Orange County: <br />Mental Health in Early Childhood <br />(Birth - Elementary) <br />Mental Health in Adolescents <br />(Middle School — High School) <br />Mental Health in Young Adults <br />Mental Health in Mid -Life <br />Mental Health for Well to Moderately - Impaired Elderly <br />Mental Health for Severely - Impaired Elderly <br />