Mental Health First Aid 12-hour Course Registration
Date and Time
Friday Mar 22, 2013
9:00 AM - 4:00 PM PDT
Fees/Admission
A Community Mental Health Trainer will follow up with you to provide details of the class. If you have any questions, or if you would like to schedule a free class for your group, agency, or organization please email MHFA@Tricitymhs.org or
call (909) 784-3249.
Contact Information
(909) 784-3249
Send Email
Description
Mental Health First Aid 12-hour Course Registration
Name____________________________________________________________________
Phone number, if any _______________________________________________________
E-mail address, if any _______________________________________________________
Occupation and employer name, if any _______________________________________
Which of the three cities are you affiliated with? (circle one) Pomona, La Verne, Claremont
(This class is intended for those that live, work, or serve in the Tri-City area)
How did you hear about this program? _________________________________________
(From whom or location of flier)
Brief description of why you’re enrolling in the course:
(examples: help family member or loved one, better serve
clients/public with mental health issues, seeking general mental health information)
Saturdays
Saturdays
March 1, 8, 15 & 22
9am - 4pm
Pomona-in Spanish
Wednesday Mornings
April 3rd & 10th, 17 & 24
9am-12pm
La Verne-in English
Circle the option(s) above that work for you
To register, please email the information to MHFA@tricitymhs.org or FAX this form to (909) 865- 0867.
These times do not work for me, but I would like to hear about future free
A Community Mental Health Trainer will follow up with you to provide details of the class. If you have any questions, or if you would like to schedule a free class for your group, agency, or organization please email MHFA@Tricitymhs.org or
call (909) 784-3249.