AshaKiran’s 2017 Annual Cultural Competency in Crisis Intervention (CCCI) Workshop Registration Form
Register to attend the 2017 AK CCCI Workshop 'Building Culturally Competent Services in Response To Domestic, Sexual & Family Violence in Asian Communities.' You will receive additional training details once you submit your application.
What is your First and Last Name
What is your title?
What is the name of your department or organization?
What is your mailing address?
What is your contact phone number?
Please check appropriate registration fee:
CEU/NBCC / $20 (Lunch Included)
General Admission / $15 (Lunch Included)
UAH Student / FREE (Conference Only/Lunch Not Included)
Please check appropriate continuing education hour type:
Please check how you would like to make your payment:
I will mail a cash or a check payment (payable to AshaKiran) to: AshaKiran, Annual Workshop, PO BOX 1021, Huntsville, AL 35807
I am a UAH Student and I would like to attend the workshop for free.
Please indicate your lunch preference:
UAH Student (FREE Admission = Conference Only/Lunch Not Included)
Would you like to know about upcoming educational workshops, fun community events & announcements, volunteer opportunities at AshaKiran and other community organizations?
YES, I would like to receive biweekly AK community updates & quarterly e-Ashavani Newsletter!
No, I would not like to receive biweekly AK community updates & quarterly e-Ashavani Newsletter!
How did you hear about the 2017 AK CCCI training program? Please check all that apply.
AshaKiran Community Announcement and/or e-AshaVani Newsletter
Newsletter/Bulletin/Calendar from another Community Organization
Another Community Calender
AshaKiran Booth Display at an event
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