ADVOCATES FOR JUSTICE AND EDUCATION

INVITES
PEER LEADERSHIP INSTITUTE

Parents or family members of a child with

special needs

To participate in the
“Parent to Parent Leadership Institute”

The Institute will be held at

4201 Georgia Avenue. NW. Washington D.C. 20011
(the Lillian Cooley Murrell Building)
202-265-1730

Saturday, May 9th, 2009 and Saturday May 16, 2009.

From 9:00 AM – 3:00 PM

Lunch will be provided.

FOR MORE INFORMATION CONTACT:
AJ Dhali
(202) 678-8060 x. 15
Email: adhali@aje-dc.org

(the Registration Form is on the back of this page.)

 ADVOCATES FOR JUSTICE AND EDUCATION, INC.
2041 Martin Luther King, Jr. Avenue, SE, Suite 400 • Washington, DC 20020
(202) 678-8060 • (202) 265-1432 Español • (202) 678-8062 Fax •
(888) 327-8060 – Toll free for parents •Website: www. aje-dc.org • E-mail: Information@aje-dc.org

Parent to Parent
Peer Leadership Institute
Saturday May 9 & May 16, 2009
9:00 AM – 3:00 PM
4201 Georgia Avenue.
Washington D.C. 20011
(202) 265-1730

Registration Form

Mr. /Mrs. _____ First Name ___________________ Last Name: _________________

Address: __________________________________________________________

City: ____________ State: __________ Zip Code: ______ Ward: _______

Telephone: ______________ (day) _____________ (night) ______________ (cellular)

Peer Leadership Institute

More information:

Do you need? (Lunch will be provided on both days)

□ Special Diet: _________________________________________________

□ Childcare
Name: ______________________________ Age of child: _____________

School attending? _____________________ Any disability? __________

Does the child need special services? _________________________________

________________________________________________________________
________________________________________________________________
□ Other Accommodations:
________________________________________________________________
________________________________________________________________
Sign up as soon as possible because space is limited!
Please mail, fax or email this form to:
AJ Dhali
Advocates for Justice and Education
2041 Martin Luther King, JR. Avenue, Suite 400
Washington DC 20020
202-678-8060 phone
202-678-8062 fax. Email: adhali@aje-dc.org