Facility Name                              Contact Person                                  Area Code & Phone No. Facility Address                         City                                                      State & Zip Code             Email Address                                                                                                                                       Name of Participant  Title of Course                           Date                  Location                Fee                                                                                                                                Total Fee                                                                                                                                                 Check No. Mail check to:  Care Home Services, Inc                             P.O. Box 3579                             San Leandro, CA 94578-0579      Fax Registration to:   1.800.474.1284 Payment must be made within 72 hours of received fax, and no later than 3 days prior to  the date of the class, otherwise, registration will be voided.        Walk-In Registrations are welcome on a space available basis BUT ARE NOT GUARANTEED Applicable fee must be paid prior to the beginning or the class. Please arrive 20 minutes early. Call 1.800.474.1284 to check availability  prior to class.