nriAHEC: Training Registration

Northern
Rhode Island
Area Health
Education Center

1 Cumberland Plaza,
(Blockbuster Building)
2nd Floor
Woonsocket, RI 02895

Tel: 401.356.4077
Fax: 401.356.4269

Training Registration

Please fill out the following form to register for one of nriAHEC's trainings.
Thank You!

Name:
Age:
Race:
Profession:
Employer:		Email:
Daytime Phone: (xxx-xxxx)
Address:		Town/City:
State:		Zipcode:
Training:
Have you attended one of our traings in the past?	Yes	No

Languages You Speak:

English

Spanish

Portuguese

Other

Educational Institution Attended:
Course of Study:

Degree attained:

AA(Associates)

BA/BS (Bachelors)

MA/MS (Masters)

Other

Additional Information or Needs
Please enter any additional information such as special needs below

Rhode Island Area Health Education Network