MHFA Registration 08 19 2016 (PDF)

Registration Form

Mental Health First Aid Training
Friday, August 19th, 8:30 a.m. – 5:00 p.m.
Participants become certified in Mental Health First Aid.

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Mail your registration form and payment of $45 by August 16th, 2016 to:
Family & Children’s Place
Attn: Tomy Molloy
525 Zane Street
Louisville, KY 40203
Payment of $45 can be made by:
a. Check or money order with registration
b. Pre-payment with credit card can be made by calling Tomy at Family & Children’s Place,
502-855.6048. If calling with credit card, you can email your registration form to
tmolloy@famchildplace.org

$45 and registration form will reserve your seat
Limited to 30 participants, registration fee includes boxed lunch on Friday, snacks and Mental Health First Aid Manual.

Please complete below and send with payment

Name____________________________________________________
Organization_______________________________________________
Address___________________________________________________
City, State and Zip___________________________________________
Best phone number to reach you _______________________________
Your email address__________________________________________
Please order me a vegetarian lunch option (check if applicable) ______