BESST Training Registration Form*

This training is for participants willing to conduct community-based parent/childcare provider trainings to reduce the risk of Sudden Infant Death (SIDS).

Please fill in your information below to register for the free training.
*An electronic confirmation will be sent once registration is processed.

First Name:

 

Last Name:

 

Title:

 

Position:

 

Department:

 

Organization:

 

County(ies) served:

 

Street Address:

 

City State Zip

 

Work Phone:

 

Fax:

 

Email Address:

 

Special Needs:

 

A number of travel stipends will be available to community-based staff.
________ Please check here if you are interested in applying.

Please Select the Appropriate Training Date:

______________Greensboro, NC: Friday, May 16, 2008 9 AM - 4:15 PM
______________Greenville, NC: Monday, May 19, 2008 9 AM - 4:15 PM
______________Fayetteville, NC: Tuesday, May 20, 2008 9 AM - 4:15 PM
______________Morganton, NC: Tuesday, June 3, 2008 9 AM - 4:15 PM

**Further information about the training and directions will be sent with your confirmation**

Please return the form to Marta Pirzadeh:
By Mail: NC Healthy Start Foundation, 1300 St. Mary's St, Suite 204, Raleigh, NC 27605
By Fax: 919-828-1446
By Email: