SAFE Talk Registration
 This is a certification course you will receive $100 stipend, and your certificate will be good for three years.
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What date are you registering for? *
Last Name
First Name
School
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Phone Number
Email
I will join you for a lunch from 12:00-12:30.
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Food Restrictions
Do you need childcare?  If so, please provide ages of your children and any accommodations they might need.
Brief description of why you are enrolling in the course.
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