Registration for QPR Suicide Prevention Training First Name * Last Name * Email * Town/Organization * Phone * Attendee 1 Name * Attendee 1 Phone * Attendee 1 Email * Attendee 1 City * Attendee 1 State * Attendee 1 Date * 6/6/24 (10:00 - 11:45 am) 6/17/24 (5:00 - 6:45 pm) Attendee 1 Service Sector * (Select/Deselect All) Park, Rec, & Camp Youth & Family Human Seniors Attendee 2 Name Attendee 2 Phone Attendee 2 Email Attendee 2 City Attendee 2 State Attendee 2 Date 6/6/24 (10:00 - 11:45 am) 6/17/24 (5:00 - 6:45 pm) Attendee 2 Service Sector (Select/Deselect All) Park, Rec, & Camp Youth & Family Human Seniors Attendee 3 Name Attendee 3 Phone Attendee 3 Email Attendee 3 City Attendee 3 State Attendee 3 Date 6/6/24 (10:00 - 11:45 am) 6/17/24 (5:00 - 6:45 pm) Attendee 3 Service Sector (Select/Deselect All) Park, Rec, & Camp Youth & Family Human Seniors Payment Method * Send Invoice Credit Card (CRPA will email an invoice that is payable online) By selecting "Yes" below, I agree that: (1.) Payment must be received by 5/23/24 in order to have access to the 6/6/24 Zoom Meeting and by 6/3/24 for the 6/17/24 Zoom Meeting; (2.) No refunds for cancellations after 5/23/24 when registering for the 6/6/24 training and after 6/3/24 for the 6/17/24 training; (3.) Registrants that do not attend the Zoom meeting without cancelling prior to this date will still be responsible for payment. * Yes No All attendees are 18 years of age or older (attendance is limited to individuals that are at least 18 years of age) * Yes No Are you human? Protected Form
