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Training | @

The Center

Training Registration

Learning to Build Your Future

Wednesday, May 20th, 2009 l Time: 9:30am - 12:30pm
Registration and a continental breakfast begin at 9:00 am. This training will be held at the Coalition's offices located in lower Manhattan at 90 Broad Street, 8th. Floor.


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Session

Personal Information

* Required fields.

* First Name:
* Last Name:
* Organization:

If your agency name does not appear in drop down list, select "OTHER" at the bottom of the list and enter the name of your organization in the field that will appear below.

You must write-in your organization name:
Department/Program:
* Title:
Designation:
Ex: RN, MD, PhD, LCMS
* Address:
* City:
* State:
* Zip:
* Phone: Ext
* Email Address:

Method of Payment

Online Credit Card
Mail (check or credit card)
Fax (credit card)

Cancellation Policy

* I agree that my agency will be charged $50 if I do not cancel my registration at least one business day prior to the training. Please email dshort@coalitionny.org to cancel your registration