table of contents

Registration Form for Core CPS Training

For a printed form, contact:
Angela Ferris
CPS Program Assistant
CPSTI/FLDC
33 Thornwood Dr., Suite 300
Ithaca, NY, 14850
607.254.6424
Fax 607.254.6447
email: amf6@cornell.edu

Cycle

(please check 1):
                Week 1                    Week 2
                -----------------         --------------------
 Cycle A    Oct 3 - 7, 1994           Oct 31 - Nov 4, 1994 
 Cycle B    Oct 17 - 21, 1994         Nov 14 - 18, 1994 
 Cycle C    Dec 5 - 9, 1994           Jan 9 - 13, 1995 
 Cycle D    Jan 23 - 27, 1995         Feb 13 - 17, 1995  
 Cycle E    Feb 6 - 10, 1995          Mar 6 - 10, 1995
 Cycle F    Mar 13 - 17, 1995         Apr 10 - 14, 1995
 Cycle G    Apr 17 - 21, 1995         May 1 - 5, 1995 
 Cycle H    May 15 - 19, 1995         Jun 5 - 9, 1995
 Cycle I    Jun 19 - 23, 1995         Jul 10 - 14, 1995
 Cycle J    Jul 17 - 21, 1995         Aug 14 - 18, 1995
 Cycle K    Aug 21 - 25, 1995         Sep 18 - 22, 1995

Candidate Name:

M/F:

Smoker?:

Title:

Supervisor:

CPS Start Date:

Social Security #:

Contact Person:

Contact Title:

County:

Address:

Phone:

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