ASIST Training Registration Form

ASIST Training Registration

Applied Suicide Intervention Skills Training (ASIST) Two-day interactive workshop Registration Form
SaveCenla offers ASIST: A two-day interactive workshop in suicide first aid. The LivingWorks ASIST program teaches participants to recognize when someone may have thoughts of suicide and work with them to create a plan that will support their immediate safety.

COST: FREE (VALUED AT $300 / PERSON) TIME: 8:00 am to 4:30 pm both days.
PLEASE NOTE:
PLEASE DO NOT REGISTER IF YOU ARE NOT COMMITTED TO ATTENDING THE TWO FULL DAYS, AS YOU MAY BE BILLED $150 IF YOU DO NOT COMPLETE THE FULL TWO DAYS.
Name:*

PrefixFirst NameLast Name
Event Location *
Event Date*

MonthDayYear
Beginning Date
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
ex: johnsmith@me.com
Phone Number*
Phone Number for Texting if Different
Event Location*
Workplace*
Occupation*

ClergyCounselorNursePhysicianPsychologistSocial WorkerAdministratorEducatorLaw EnforcementVolunteerYouth WorkerOther
If "Other", please specify
Are you a student in the Avoyelles Parish School District?

YESNO
Projected Graduation Year
As the world’s leading suicide intervention workshop, ASIST program is supported by numerous evaluations including independent and peer-reviewed studies. Results demonstrate that ASIST helps participants become more willing, ready, and able to intervene with someone at risk of suicide. ASIST is also proven to reduce suicidality for those at risk.

For General Information email us: info@savecenla.com
Angela Dixon (337)519-1888
Andy Dixon (337)288-0973
Have you attended ASIST with us before?

YesNo
If yes, which group were you on?

AndyAngieSomeone elseThis will be my first ASIST attendance
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