Mental Health First Aid Training Registration

Welcome to Mental Health First Aid Training!

If you are registering for another person, or for one or more individuals, please provide names and contact information for all individuals who will be attending the class.

* = required field

Please select the date for which you are registering: *

2/27 and 2/28, 8:30 am - 12:30 pm

4/21 and 4/22, 8:30 am - 12:30 pm

6/3 and 6/4, 8:30 am - 12:30 pm

9/29 and 9/30, 8:30 am - 12:30 pm

11/4 and 11/5, 8:30 am - 12:30 pm

Name *

First

Last

Name - Second Registrant

First

Last

Name - Third Registrant

First

Last

Address *

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Address - Second Registrant

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Address - Third Registrant

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Phone Number *

###

####

Phone Number - Second Registrant

###

####

Phone Number - Third Registrant

###

####

Email Address *

Email Address - Second Registrant

Email Address - Third Registrant

Are you or any individual you are registering for an active member of the military, a veteran, or a military/veteran family member?

Billing Address & Payment

Please enter your billing information as it appears on your credit card.

Billing Name *

First

Last

Billing Email *

Billing Address *

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Credit Card *

Number

Expiration (MM-YYYY)

CVV Code

Total

Your total charge will be: $70.00

Mental Health First Aid Training Registration

Welcome to Mental Health First Aid Training!

Billing Address & Payment

Total

Address & Contact

Towson Campus

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