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REGISTRATION FORM

Mental Health First Aid - January 9 - 2025

Billing Information

Hospital/Organization/Business

First Name

Last Name

Hospital/Organization/Business Address

Hospital/Organization/Business Address 2

City

State

Zip Code

Phone Number

Email Address

Registration Information

RWHC Member & Affiliate Member

$250.00 per participant

Non-RWHC Member

$300.00 per participant

Cancellation Policy: Cancellations received up to two weeks prior to a program will receive a full refund, less a $25 processing fee. No refunds will be given for cancellations received less than two weeks prior to the program. Substitutions are accepted.

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What is the Participant's Work Title?

How did you hear about us?

If "other", please list source:

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