Train the Trainer September Registration

Train the Trainer Workshop | September 3, 2026

Use this form if paying by check or if your company does not appear in the online dropdown.
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.

Other
RN or Pharmacist License #
Member Rate - $150 / Non-member Rate - $200
My organization is a member of (select one):
Company / Center Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payment Information

If paying by credit card, we will contact you.
I will be paying by
Contact for Payment
Payment Contact Email Address
example@example.com
Payment Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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 September 3, 2026.

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

By submitting this form, I acknowledge that I have read, understand, and agree to abide by all rules, terms, and conditions outlined above. I understand that all registrations are final and that no refunds will be issued.
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Train the Trainer Workshop | September 3, 2026