BESST Training Registration Form*

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:

Please check which training you are interested in:

______________Tuesday, April 28, 2009; 10 AM - 12 PM - Project Enlightenment, Raleigh (Training Full)
______________ Thursday, April 30, 2009; 10 AM -12 PM - Robeson County Health Department, Lumberton
______________Tuesday, May 12, 2009; 10 AM - 12 PM - Project Enlightenment, Raleigh (Training Full)

______________Please notify me as other trainings are scheduled. I need another date or location
______________I have a potential training site in my community

Other trainings will be announced throughout the Spring. If you are interested in hosting a trainining, please contact Marta Pirzadeh at the North Carolina Healthy Start Foundation

______________I am interested in applying for a travel stipend

**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:

BESST Training Registration Form*

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

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