YES, I’d like to attend this FREE Program. Seats are limited, please return this form via fax, mail or call us. 

Company Name: _________________________________    How many will be attending: ______________________

Name (s): _______________________________________    Position: ______________________________________

Address/City/Zip: ________________________________     Phone: ________________________________________

Email: _________________________________________

Mail or Fax to:
Solutions EAP
213 Court Street, 8th Floor                 Fax: 860-704-6221
Middletown, CT 06457                       To Call for More Information: 1-800-526-3485