Registration Request Form

This form is intended to request registration for the Intentional Peer Support 5-day Core Training scheduled for Monday, March 12 through Friday, March 16 at Holyoke Community College in Holyoke, Massachusetts.

Please note that filling out this form constitutes a REQUEST to register. Confirmation of registration will be sent based on space available. You are not formally registered until you have received confirmation.

* 1. Please complete all fields below.

* 2. Tell us a bit about who you are in relation to this training.

* 3. Are you able to attend all five days of the training?

* 4. If you are unable to attend all five days of the training from start to finish, please tell us more about what you'd need to miss.

* 5. Are you or your employer able to pay the $140 registration fee?

* 6. If requesting financial assistance, are you requesting a free registration or a reduction? If a reduction, how much are you able to pay?

* 7. If requesting financial assistance, can you tell us a bit about how you intend to use this training, or how you think it will benefit you?