ADA Seminar Registration   Name:  __________________________________________   Address:  ________________________________________   City, State, Zip: ___________________________________   Phone:  _________________________________________   Agency Affiliation (if any): ___________________________   Do you need CEUs for this seminar?  Yes ____  or No ____   Please make checks payable to: Central Illinolis Recovery Coalition (CILRC)   Mail Completed form and payment to:               Central Illinois Recovery Coalition             C/O IAODAPCA                   401 E. Sangamon Ave.             Springfield, IL 62702   Questions or comments:  Call Maria Moubarik at (217) 553-1566