1. Contact Information:
2. I represent (check only one):
3. Organization Information:
4. If you selected Addiction Services Provider or Mental Health Provider above, please submit the following information:
5. Check below if you would like to be contacted regarding an ADA accomodation.
6. Please select the College location and date you would like to attend (select one per column). All classes are from 8:30 am to 4:00 pm.
First ChoiceSecond Choice
7. If a training location above is unavailable, please select the county where you would like to receive training from the locations below. Once a class in that county is scheduled, you will be contacted by the Registration Team.