Mental Health First Aid Training Registration Form

 

 

 

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 15^th, 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
 

Registration 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 .