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.

Please complete all fields below.

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* 1. Please complete all fields below.

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

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

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

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

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.

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* 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.

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

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

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

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

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?

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* 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?

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