HEALTHY TRANSITIONS INITIATIVE GRANT COMMUNITY MEETING (in conjunction with the 24th Annual Children’s Mental Health Research and Policy Conference “Tampa Conference”) March 20 - 23, 2011 Hyatt Regency ~ Tampa, Florida

Meeting R.S.V.P. Form

State Delegation Leader: State:

Please complete the table below with the names of the team members attending the HTI Grant Community Meeting at the 24th Annual Children’s Mental Health Research and Policy Conference. Also please indicate their role in the community, i.e., youth, family member. This information is needed so that we may have an accurate count for planning purposes. There is no additional cost to attend the HTI meeting. Please complete and return this form by Friday, February 11, 2011 to Marina Nalvarte at [email protected].

Please note, all state state members must be listed below. Additional members identified after this form has been submitted, must be forwarded to Marina Nalvarte immediately so we can ensure we have adequate space.

Reminder: HTI meeting attendees will need to register separately for the Tampa Conference; this form is not registration for the Research & Policy Conference.

Full Name Role in Community Phone Number E-mail

1

2

3

4

5

6

7

8

9

10