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: