CIT Companion Course for Behavioral Health Professionals Registrations 2019

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Use this form to register for the September 25-26 2019 Crisis Intervention Team Companion Course for Behavioral Health Professionals. The training is free to staff of Tri-County Board provider agencies in Darke, Miami or Shelby County (Ohio). Registration will be limited to 20. A wait list will be maintained for registrations over 20. CEUs are available

First name *

Last name *

Job Title *

Agency/Provider *

Community Housing Inc/Shelby House/Miami House

Family Resource Center

Miami County Recovery Council

Recovery and Wellness Centers of Midwest Ohio

SafeHaven Inc

Other:

Email address *

Please provide an email address where we can send you information about the training

Phone number *

Please provide a phone number where you can be reached with late-breaking updates

Professional Licence Number (for CEUs)

Dietary restrictions

Light breakfast and lunch are included. Please note any dietary restrictions

Comments

Please add any additional comments

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