437 Railroad St., Bridgeville, PA 15017
REGISTRATION FORM
Mental Health First Aid Training
Mental Health First Aid Training (MHFA) is an 8-hour course designed for people with no clinical training who work/live in the community. You are registering for the training on Friday, April 15th, Chartiers Center Board Room, 8:30am – 4:30pm. Registration will open at 8:00am and the course will include a continental breakfast and lunch. There is no charge for the training, but registration is required. The training is funded by Allegheny County Health Initiative (ACHI).
Return your registration form to Mary Kay Bonn (412) 221-3302 ext.118 or mbonn@chartierscenter.org
Name __________________________________________________________ Date ______________
Address ___________________________________________________________home_____work___
City ______________________________________State ______________Zip Code ______________
Phone ___________________________________ email address ______________________________
Occupation __________________________ Employer ______________________________________
How did you hear about the mental health first aid training at Chartiers Center?
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Will this training fulfill any requirements for work or school? _______ yes _______ no
If yes, please specify _________________________________________________________________
Please provide the names and contact information for anyone else you know who might like to attend:
__________________________________________________________________________________
__________________________________________________________________________________
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Signature Date
Registration is open to the first 24 applicants. A follow up email will follow with specifics to the training.
Return your registration form to Mary Kay Bonn (412) 221-3302 ext.118 or mbonn@chartierscenter.org .