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: 50 MB. Select the training dates you will attend:(Required)April 16-18, 2025July 16-18, 2025October 16-18, 2025Please 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 Code Core Training Price: Discount $0.00 Total Credit Card(Required)Card Details Cardholder Name
