First Name
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Last Name
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First Responder Role/Title
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Please Select
Law Enforcement
Paramedical
Emergency Health Care Workers
Fire Services
Indigenous Peoples
Family Members
Other (Please detail in the Notes field at the end)
Organization / Municipality (if applicable)
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Email
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Phone Number
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Preferred Training Dates (see above). It is recommended to choose more than one date if possible
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How did you hear about the program?
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AMHSA Website
AMHSA Newsletter
Mental Health Commission of Canada
TELUS Health
Social Media
Media Release
Professional Association
Referral
Other
What is your Professional Association? Or who was your referral?
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Please add any questions or information that you would like us to know
Please verify that you are human
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