Train the Trainer June Registration

Train the Trainer Workshop

Registration Form for those paying by check - June 4, 2026
IF PAYING BY CREDIT CARD CLICK HERE.

HCANJ regrets that we are unable to offer refunds for canceled registrations and no-shows.

Registrant substitutions from the same center are acceptable and must be submitted to michelle@hcanj.org 72 hours prior to the training date.
Name*

First NameLast Name
Title*
Attendee Email*
example@example.com
Please check all that apply.*

RNLPNPharmacistOther
RN or Pharmacist License #*
Member Rate - $150 / Non-member Rate - $200
My organization is a member of (select one):*

HCANJNJHALeadingAge NJ/DENone of the above
Company / Center Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact for Payment*
Contact Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Thank you for taking the time to complete this form!

By submitting this form, I agree to pay the fees to attend the HCANJ Train the Trainer Workshop on June 4, 2026.

If you have questions regarding the program,
please call or email Michelle Palko at 609-890-8700 or michelle@hcanj.org.
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Train the Trainer Workshop