A Matter of Balance Coaches Training Registration Form

Important Information:

Date: Thursday, October 9th & Friday, October 10th

Time : 10:00am- 2:30pm (30 min lunch provided)

Location: Piscataway Community Center, 520 Hoes Ln, Piscataway, NJ 08854

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* 1. Name:

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* 2. Organization:

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* 3. Home Address:

Address

City/Town

State

ZIP/Postal Code

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* 4. Mobile Phone Number:

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* 5. Work Phone Number:

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* 6. Email (That you check regularly):

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* 7. I understand that I must attend both sessions of the two-day training on October 9th and 10th in order to become a certified Matter of Balance coach.

Yes

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* 8. I understand that I am expected to facilitate two (2) Matter of Balance workshops within one-year of certification to remain in good standing with the MCESFPN.

Yes

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* 9. I understand that I am required to attend 2.5 hours of MOB Facilitator Training annually (provided by the MCESFPN) in order to maintain my coach certification.

Yes