Mental Health First Aid 12-hour Course Registration

Description

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
nd
 
Mental Health First Aid
12-hour Course Registration
 
Saturdays
March 2
nd
 & 9
 
9am-4pm
th
Pomona-in Spanish
Wednesday Mornings
April 3
rd
 10
th
 17
 &
24
 
9am-12pm
th

Circle the option(s) above that work for you
th
La Verne-in English
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.