Mental Health First Aid 12-hour Course Registration

Description

Mental Health First Aid 12-hour Course Registration

Name____________________________________________________________________

Phone number, if any _______________________________________________________

E-mail address, if any _______________________________________________________

Occupation and employer name, if any _______________________________________

Which of the three cities are you affiliated with? (circle one)   Pomona, La Verne, Claremont
(This class is intended for those that live, work, or serve in the Tri-City area)
 
How did you hear about this program?  _________________________________________
(From whom or location of flier)

Brief description of why you’re enrolling in the course:
(examples: help family member or loved one, better serve
clients/public with mental health issues, seeking general mental health information)
Saturdays
Jan.12th & Feb.2
 9am-4pm
Claremont-in English

Saturdays
March 2nd & 9th
9am-4pm
Pomona-in Spanish

Wednesday Mornings
April 3rd & 10th, 17 & 24
 9am-12pm
La Verne-in English

Circle the option(s) above that work for you

To register, please email the information to MHFA@tricitymhs.org  or FAX this form to (909) 865- 0867.  
These times do not work for me, but I would like to hear about future free
A Community Mental Health Trainer will follow up with you to provide details of the class.  If you have any questions, or if you would like to schedule a free class for your group, agency, or organization please email MHFA@Tricitymhs.org or
call (909) 784-3249.