CrisisReady Howard County
Event Registration
November - Cold Weather Preparedness
and
QPR Suicide Prevention Training
Full Name
*
First Name
Last Name
Phone Number: If the CrisisReady event you have registered for is rescheduled at the last minute, we will call you to inform you of the change.
E-mail: Your QPR certificate will be emailed to the email address you provide.
*
example@example.com
At which location do you plan to attend the CrisisReady presentation?
*
Greentown Century Villa Community Room on November 6th at 6:30pm
Kokomo-Howard County Public Library Main Branch, Meeting Rooms A & B, on November 13th at 5:30pm
Russiaville Lions Club on November 19th at 6:30pm
Attending QPR course only, not signing up for CrisisReady presentation
Do you plan on attending the QPR Suicide Prevention first aid skills training? The training will take approximately 1.5-2 hours.
*
Russiaville Lions Club on November 12th at 6:30pm
Kokomo-Howard County Public Library Main Branch, Meeting Rooms A & B, on November 13th at 10am
I don't know
If you plan on bringing friends or family with you and they are not registering, please provide an estimate of how many people will attend with you.
We take pictures of our events for social media and for local and state reports of our activities. Please confirm that you consent to your picture, if taken, to be used in these reports and to posted to social media.
Yes, any pictures I am may be used in the reports and posted to social media.
No, any pictures that I am should not be used in the reports or posted to social media. (You will have to let us know during the event so we can avoid placing you in pictures. We do NOT accept responsibility for accidentally posting your picture if we are not informed at the event.)
Would you like to receive a monthly email reminder about upcoming CrisisReady events?
Yes
No
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