The Center

Training Registration

Comprehensive Benefits Management Training

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 one business day prior to the session. Please email dshort@coalitionny.org to cancel your registration.