Copy this form, click on the email below and paste this form it into the email. Fill in the form and send.

ejb179@psu.edu

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Littlestown PROSPER

Strengthening Families Program Registration Information

Family Name ________________________________
Parent’s Name(s):_________________________ , ____________________________ - (for name tags)

Student’s Name: _________________________, _________________________, _____________________

Address:

Phone: Home ______________ Work _______________ Email _______________

Which session would you attend:

Tuesday's Session will start January 27th and end on March 10th, 2009

Dinner 6:00PM Sessions 6:30PM to 8:30PM

Yes, our family will eat dinner at the program site. Number for meal planning ____