Mental Health First Aid Registration Participant & Billing information Question Title * 1. Please enter the participant's contact information. Name E-mail Address Re-enter e-mail address Telephone Number Question Title * 2. Who will pay the bill for this class? The charge will be $25.95. Participant Agency Other (please specify) Question Title * 3. Please enter the billing information. Attention to: Name E-mail Address Re-enter e-mail address Telephone Number Mailing Address City State Zip Code Next