Training Registration

Name(Required)

First Last

Phone(Required)

Email(Required)

Agency/Organization (if applicable)

Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Which training are you registering for?(Required)

Youth Mental Health First Aid (YMHFA)

Question, Persuade, Refer (QPR)

Applied Suicide Intervention Skills Training (ASIST)

Youth Mental Health First Aid(Required)

Thursday, May 1st – 9:00 AM to 5:00 PM - 1207 SW Executive Drive, Suite B, Topeka, KS 66615

Question, Persuade, Refer (QPR)(Required)

Friday, April 25th – 12:00-1:30 PM - 1207 SW Executive Drive, Suite B, Topeka, KS 66615

How did you hear about this training?(Required)

Do you require any accommodations to participate in this training?(Required)

Questions, comments, concerns?