METH DOES NOT

METH DOES NOT
DISCRIMINATE
FreE EvenT / OpeN TO PubliC
SEPTEMBER 21, 2010
8:00 am - 4:30 pm
Moenkopi Legacy Inn • Tuba City, AZ
METH DOES NOT
DISCRIMINATE
September 21 2010 • Moenkopi Legacy Inn • Tuba City, AZ
REGISTRATION FORM
Date: __________________________
First Name: ___________________________________ Last Name: ___________________________________
Job Title: ___________________________________ Organization: ___________________________________
Mailing Address: ____________________________________________________________________________
City: _______________________________________ State: ____________________ Zip: ________________
Phone: ______________________________________ Email: ________________________________________
Gender: (Check One) ❑ Male
❑ Female
Age: ❑ 9-24
❑ 25 - 34
❑ 35 and older
Community you reside in: ______________________________________________________________________
How did you find out about this training:
❑ Received telephone call/message.
❑ Received an e-mail.
❑ Other ______________________
Are you interested in being involved in other Meth and/or Suicide Prevention Activities?
❑ Yes
❑ No
❑ I can’t commit just now, but keep me informed.
Return completed form to:
Tuba City Suicide Prevention Task Force
Mental Health Department
P.O. Box 600
Tuba City, AZ 86045
REGISTRATION DEADLINE
Wednesday, September 17, 2010
Fax to 928-283-2832 or email to [email protected] OR Fax to Lavina Begay-Nez at 928-283-3039.
Certificates of attendance will be provided to participants. Please register as soon as possible for there are a
limited number of seats. For more information, call Ruth at 928-283-2831 or Lavina at 928-283-3346.
METH DOES NOT
DISCRIMINATE
September 21 2010 • Moenkopi Legacy Inn • Tuba City, AZ
HOTELS AND RESTAURANTS
HOTELS
RESTAURANTS
• Moenkopi Legacy Inn & Suites
U.S. 160 and Road 260
Tuba City, AZ 86045
Phone: (928) 283-4500
• Hogan Restaurant
• Subway
• Golden Rice Bowl
• Quality Inn
10 North Main Street
Tuba City, AZ 86045
Phone: (928) 283-4545
• Diné Inn Motel
U.S. 160 & Peshlakai Ave.
Tuba City, AZ 86045
Phone: (928) 283-6107
• Bashas’ Deli
• Kate’s Café
• Taco Bell
• McDonald’s
• Sonic Drive-In
• Greyhills Inn
U.S. 160 & Warrior Dr.
Tuba City, AZ 86045
Phone: (928) 283-4450
• Tuuvi Café