UMatter for Schools Youth Suicide Prevention:

The Lifelines Curriculum Training

Click here for complete details of this training

Location: Montpelier, VT
Dates: Mar 30, 2010
Times: Breakfast Buffet 8:00am – 9:00am
Registration 8:30am – 9:00am
Workshop 9:00am – 4:00pm
Cost: $35 covers training and food. Participants are responsible for all travel-related expenses.

An additional fee of $150 per school covers the cost of the Lifelines curriculum.

IMPORTANT: Please include your name and the course title in the memo section of your check or purchase order. Thank you.

Umatter is underwritten by the Garrett Lee Smith Memorial Act.

Please fill out the following information.

Participant Information:
Title	First name	Last name

Email Address

Email Address (again)

Organization or School Information:
Organization

School
(Pick 'none' if this doesn't apply.)
Other School

Other Supervisory Union

Street Address Line 1

Street Address Line 2 (Optional)

City

State	Zip

Work Phone Number

Work Fax Number

NOTE: So we can contact you in the event of cancellation, please provide your home phone number:
Home Phone Number (Please see note above)

Billing Information:
Purchase orders must be training specific; however, multiple registrants for the same training can be on the same purchase order.
Payment Type	PO # / Check

Billing Contact Name

Billing Organization

Street Address Line 1

Street Address Line 2 (Optional)

City

State	Zip

Phone Number

Fax Number

Personal Information:
Organizational Role

Other Organizational Role

How did you hear about this training?

Other way you heard about this training if not in list above.

Please complete the following pre-assessment questions:
What will be your role in the Lifelines Program??
Administrative Sponsor School Liaison Community Liaison Health Educator