FACES - Registration Form - Berlin

All Classes are being held at Androscoggin Valley Hospital, 59 Page Hill Rd, Berlin, NH

        To register, complete the form below:

First Name:
(required)
Full Middle Name:
(If no middle name enter "none")
(required)
Last Name:
(required)
Date of Birth:
(Please use this format: mm/dd/yyyy)
(required)
Home mailing address:
(required)
City:
(required)
State:
(required)
Zip code:
(required)
Home Telephone Number:
(Please use this format: xxx-xxx-xxxx)
(required)
Cell Number:
(Please use this format: xxx-xxx-xxxx)
Business Telephone Number:
(Please use this format: xxx-xxx-xxxx)
Primary E-mail Address
(required)
Re-enter Email Address
(required)
I am:
(required)
Location of District Office
or name of Private Agency:
(required)
Location of District Office or
name of Private Agency:
(required)
Other (specify role):
(required)

FACES - Berlin Series

Orientation - 1/23/18

Tuesday, 5:30pm-8:30pm

Regulations - 1/30/18

Tuesday, 5:30pm-8:30pm

The Developing Child - 2/6/18

Tuesday, 5:30pm-8:30pm

The Effects of Childhood Trauma - 2/13/18

Tuesday, 5:30pm-8:30pm

Experiencing Grief & Loss - 2/20/18

Tuesday, 5:30pm-8:30pm

Promoting Positive Behavior - 2/27/18

Tuesday, 5:30pm-8:30pm

Lifelong Connections - 3/6/18

Tuesday, 5:30pm-8:30pm

 

Payment Options