Registration Form

The Florida Supportive Housing Coalition (FLSHC) and the Florida Coalition for the Homeless (FCH) are proud to announce the 3rd Annual Statewide Supportive Housing and Homeless Conference. The conference will be held October 26 - 27 at the Hilton Clearwater Beach Resort.

We are happy to announce that the Florida Department for Children and Families is sponsoring scholarships for up to 55 individuals, contingent on funding availability. The scholarships are for registration only at the cost of $250 per person.

Please complete the form below and click the submit button. You will receive information about payment options upon submittal. FLSHC/FCH will not accept faxes for credit card payments.

Registration fees do not include membership in either the FLSHC or the FCH.

Fields marked with * are required.

If you are a conference sponsor, exhibitor or speaker, please register here.

Title:
First Name:*
Last Name: *
Agency: *
Address: *
City: *
State: *
Zip Code: *
Email Address: *
Phone:
Fax:

CONFERENCE REGISTRATION FEES*

Early Bird Full Conference Registration (Before September 1, 2009)

$275 Members
$400 Non-members

One Day Only Registration

$200 Monday, October 26 only
$175 Tuesday, October 27 only

Bus Tour:Libby Stone of HEP and Gary MacMath of Boley Center
will provide the transportation for free.

  • Pinellas Hope - Homeless Emergency project
  • Mid county Safe Haven

    • Yes, Please I will tour
    No, Thank you

    		 If your organization would like to become a member:
      (Links will open in a new window)

    PAYMENT INFORMATION*

    Please let us know how you prefer to pay for your conference registration:
    Check or Purchase Order

    CANCELLATIONS: Cancellations must be in writing and received no later than September 28, 2009 to receive a refund less a $25 administrative charge. Cancellations received after the above deadline will not be eligible for a refund.

    Credit Card

    Comptroller or Billing Contact Information:

    Name:
    Phone:
    Email:

    SPECIAL NEEDS

    Please describe below if you have special access or dietary needs. We must be informed of your special needs by September 22, 2009 in order to accommodate them.