Colorado Area Health Education Center

CREATE Health Faculty Advisor Training
at University of Colorado - Anschutz Medical Campus

When:	June 12-14, 2013
Location:	Anschutz Medical Campus, Aurora 80045
Contact:	Jennifer Hellier, Director of CREATE Health 303-724-7865 Tony Magno, Administrative Assistant 303-724-6484
Registration Deadline:	May 30, 2013
Completing this form will secure your lodging at: SpringHill Suites by Marriott, Denver/Aurora/Fitzsimons, 13400 E. Colfax Ave. Aurora, CO. 80011 (CREATE Health will pay for lodging/meals of faculty advisor only; other family/guests accompanying faculty advisors are responsible for their own meal expenses and any additional lodging.)

First Name:

Last Name:

Address 1:

Address 2:

Address 3:

City/State/Zip:

/ /

* Work Phone:

- -

* Cell Phone:

- -

Email:

School Type:

School Name:

Number of Student Advisees:

Need Lodging:

	Yes
	No

Room Preference:

	King
	Double

Lodging for 6/12/13:

	Yes
	No

Lodging for 6/13/13:

	Yes
	No

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