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Training Registration | Professional Learning Center | The Coalition

Professional Learning Center

Training Registration

Motivational Interviewing Series


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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.

Department/Program:
* Title:
Designation:
Ex: RN, MD, PhD, LCMS
* Address:
* City:
* State:
* Zip:
* Phone: Ext
* Email Address:

Cancellation Policy

* I agree that my agency will be charged $50 if I do not cancel my registration at least 1 business day prior to the session. Please email eherrick@coalitionny.org to cancel your registration.