Supervisory Training Registration Form

Location:
Public Health Solutions
220 Church Street, 5th Floor
New York, NY 10013

The price for the 2-day Supervising to Manage Performance training is $400/person. Discounts for groups of two or more are available.

Deadline to register is one week before scheduled training dates.

To ensure that participants apply the new knowledge they have gained during the training and to clarify any issues and/or answer any questions about the training content, it is recommended that attendees register to receive two hours of post training individualized coaching via telephone and/or email assistance from the trainers. Two hours of post-training coaching is available for an additional fee of $100.

Fields marked with * are Required. Registrant 1
First Name	*
Last Name	*
Title	*
Phone	*
FAX
E-mail	*
Registrant 2 (if applicable)
First Name
Last Name
Title
Phone
FAX
E-mail
Organization
Agency Name	*
Street Address	*
Address (cont.)
City	*
State	*
Zip	* -
Choose a training package:	Please select... Training session only Training session + 2 hours coaching *
Budget Size (based on latest 990 filed):
What training dates would you like to attend?:	December 8th and 15th, 2009 *
Verification:	(Please Enter the characters you see)
Once your registration has been received, you will receive an invoice and payment instructions via e-mail within 2 business days. If you wish to pay by credit card over the phone, complete the on-line registration form, then call Andrew Owens and (646) 619-6511. If you have any questions about registration or the training, please contact Andrew Owens at (646) 619-6511 or aowens@healthsolutions.org.