Navigator Academy In-Service Training - REGISTRATION FORM Thank you for registering! This four-part training session will be conducted at two different time frames: from 9 am to 1 pm or 12 pm to 4 pm. Once you register and list your preferred session (AM/PM/Both), Crystal will contact you with the information about class details and location. A Certificate of Completion will be presented to participants who complete all four modules. Classes are free; seats are limited and available on a first-come, first served basis. Registration confirmation with training site location and specifics will be emailed to you. NOTE: Capitol Health Network and Academy sponsor The California Endowment may wish to record the sessions and/or make audio or video recordings of the sessions. Feel free to forward and share this opportunity with others! Any questions, please contact Crystal Harding-Jenkins, MSW (916) 447-7222 x1015 or firstname.lastname@example.org OK Question Title * 1. First and last name OK Question Title * 2. Position/Title OK Question Title * 3. Name of organization and program or department OK Question Title * 4. Email address OK Question Title * 5. Work mailing address OK Question Title * 6. Work phone number OK Question Title * 7. Cell phone number OK Question Title * 8. Fax number OK Question Title * 9. Supervisor's contact information Full Name Position/Title Address City State ZIP/Postal Code OK Question Title * 10. What time frame works best for you? 9am-1pm 12p-4pm Open, both work Other (please specify) OK SIGN ME UP!