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Sexual Coercion

Thank you for registering for the Indiana Family Health Council Sexual Coercion Training to be held on June 20, 2016. There are limited seats available with priority going to staff at Title X funded sites. Please complete the following questions. For those not working in a Title X site, the registration fee is $40.

1.Name

First Name

Last Name

2.What is your email address?

3.What is your phone number?

4.Where do you work?

5.IFHC will be ordering from Indy Anna's. Which option would you like for lunch?

Any alterations to the lunch options (i.e., no cheese, no bread, etc.)

6.Are you interested in Continuing Nurse Education hours?

Yes

No

7.Are you attending as a Title X staff person?

Yes

No

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