Core Training Registration – $200 Name(Required) First Last Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code In order to register, you must have completed the attestation through Texas Health and Human Services. Have you completed this?(Required) Yes No If you have not completed this, please contact James Tapscott at [email protected].Please upload your completed Attestation of Completion(Required) Drop files here or Select files Max. file size: 128 MB. Select the training dates you will attend:(Required)October 15-17, 2025Jan 14 – 16, 2026Apr 15 – 17, 2026Jul 15 – 17, 2026Oct 14 – 16, 2026Please note: All trainings are online via Zoom from 9am-5pm.How did you hear about this training?(Required) Online search (i.e. Google) Coworker/colleague Social media Friend/Family Community event or workshop Other Discount CodeCore Training Price: Discount $0.00 Total Credit Card(Required)Card Details Cardholder Name
