Mental Health First Aid Training Registration Form

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437 Railroad St., Bridgeville, PA 15017

REGISTRATION FORM

Mental Health First Aid Training

 

Mental Health First Aid Training (MHFA) is an 8-hour course designed for people with no clinical training who work/live in the community. You are registering for the training on Friday, April 15th, Chartiers Center Board Room, 8:30am – 4:30pm. Registration will open at 8:00am and the course will include a continental breakfast and lunch. There is no charge for the training, but registration is required. The training is funded by Allegheny County Health Initiative (ACHI). 

Return your registration form to Mary Kay Bonn (412) 221-3302 ext.118 or mbonn@chartierscenter.org

Name   __________________________________________________________ Date ______________

 Address ___________________________________________________________home_____work___    

 City ______________________________________State ______________Zip Code ______________

 Phone ___________________________________ email address ______________________________

 Occupation __________________________ Employer ______________________________________

 How did you hear about the mental health first aid training at Chartiers Center?

 __________________________________________________________________________________

 __________________________________________________________________________________

 Will this training fulfill any requirements for work or school?   _______ yes    _______ no

 If yes, please specify _________________________________________________________________

 Please provide the names and contact information for anyone else you know who might like to attend:

 __________________________________________________________________________________

 __________________________________________________________________________________        

 

 __________________________________________________________________________________

             Signature                                                                                                              Date

 

logo-drop-shadow-2xRegistration is open to the first 24 applicants. A follow up email will follow with specifics to the training.      

Return your registration form to Mary Kay Bonn (412) 221-3302 ext.118 or mbonn@chartierscenter.org .