Tuesday, May 15, 2012

Mental Health First Aid Training June 14 and 15

Registration Form
 

Dates:  Thursday, June 14, 2012  9:00 am – 4:30 pm

        Friday, June 15, 2012  9:00 am – 4:30 pm



Location: MHAST- 153 Court Street – Binghamton, NY 13901



Registration Deadline is Wednesday, June 6, 2012 (No refunds after this date)



Name:  _____________________________________________________________________



                                Agency/Company Name:  ______________________________________________________



                                Agency/Company Address:  _____________________________________________________

                                                                  

                                                                                       _____________________________________________________

                                Email:  ______________________________________________________________________

                                Phone: ______________________________________________________________________



Cost:  $90.00 per person.

 (Make checks payable to Mental Health Association of the Southern Tier)



Cost includes MHFA Course Booklet, breakfast and lunch (both days).



Participants MUST attend the two full days of training to receive the certificate.



Any questions, contact Keith Leahey (keith.leahey@youmha.com) or Dawn Kirk (dawn.kirk@yourmha.com)

Or at (607) 771-8888.



                Mail completed form to:               Mental Health Association of the Southern Tier

                                                                                Attn: Mental Health First Aid

                                                                                153 Court Street, Binghamton NY 13901

                                                Or-                         Fax: (607) 771-8892

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