Winnemucca safeTALK Training Registration
April 15th, 2021
9:00 AM - 12:00 PM

Question Title

* 1. Please enter the information requested below

Last Name *

First Name *

Nick Name *

Job Title

Agency

Zip Code *

Email Address *

Phone Number *

Question Title

* 2. safeTALK has been approved for Continuing Education Units by the Dept. of Education, POST, Pharmacy, Physical Therapy, Psychological Examiners, Social Workers, and SNHD. Nurses, CPC/MFTs, ADGCs may apply Social Workers CEUs toward their license requirements.

If you need Continuing Education Units for attending this course, please enter the information below. Failure to enter the information below may delay your CEU certificate.

Licensing Agency/Discipline

License number

Question Title

* 3. We are required to train a minimum number of participants at each class. If we do not have this minimum number, the class will be cancelled. This will inconvenience many.

To ensure the minimum number of participants are in attendance, we ask that you to notify us at least 5 business days in advance. Do you agree to notify us?

Yes

No