Individual Registration

Please enter information in the form below to process registration for event Mental Health First Aid for Adults who Interact with Youth (April 13-14).

First Name *

Last Name *

Organization

Mailing Address *

Address 2

City *

Province *

Postal code *

Email *

Comment

No refund will be issued for cancellations after registration cutoff date.  Cancellations prior to this will be fully refunded.

Payment Information

Coupon

Amount

Discount Amount

Gross amount

Payment Method

Credit Card

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

WHO WE ARE

WHAT WE DO

FIND US ON

Champlain East Branch
329 Pitt Street
Cornwall , K6J 3R1, Ontario
1-800-493-8271
office@cmha-east.on.ca
Hours:
Monday to Friday 8:30am – 4:30pm

In Crisis? Call the Mental Health Helpline at 1-866-531-2600 or find your local CMHA branch.