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2019 ACKNOWLEDGEMENT OF PATERNITY (AOP) SEMINAR REGISTRATION FORM

SEATING IS LIMITED. PLEASE REGISTER AS SOON AS POSSIBLE. Refer to the seminar schedule for dates, times and locations. REGISTER: 1) Type or legibly print the requested information. 2) Email or fax the completed form to the person listed for the area where the training will be held. Central Elizabeth Galvan Alvin Garrett [email protected] [email protected] Fax (512) 358-3222 Fax (214) 915-3774 North Texas Fort Worth Erin Henriksen Liliana Gonzalez [email protected] [email protected] Fax (903) 533-4075 Fax (817) 834-7068 El Paso & Lower & Southwest Texas Barbara Ramirez Leticia Cantu & Denise Young [email protected] [email protected] Fax (915) 772-3804 [email protected] Fax (210) 337-5340 or (210) 337-5456 Greater Area & Laredo Aimee Evins Blanca Briseno [email protected] [email protected] Fax (713) 863-2844 Fax (956) 926 - 4542 Houston West Texas & Panhandle Guadalupe Matschiner Tracy Murphree & Sara Johnson [email protected] [email protected] Fax (713) 787-2641 [email protected] Fax (806) 763-7579 * * IF YOU ARE BEING RECERTIFIED, PLEASE BRING YOUR COPY OF THE AOP MANUAL. * *

Attendee (or Group Contact): ______Email: ______Telephone: (____) _____ - ______Represented Facility: ______Mailing Address: ______City: ______State: ______Zip: ______Seminar Location: ______Date/Time: ______Number of Name of Attendees: Attendees:

Revised May 10, 2019