Prime for Life - Registration
>>Training Description
PRIME For Life® is an evidence-based program that encourages individuals to think through their attitudes, beliefs, and behaviors before making high-risk drug or alcohol choices. Prime For Life® provides a judgment-free way of understanding how alcohol and drug-related problems develop, what we can do to prevent them, and why sometimes we need help.
Please use this form to answer the questions below and register for the Prime for Life program you would like to attend. Once you submit your registration you will receive a copy of your responses. Submitting this form holds you one (1) spot in the program's class that you picked. 

Class Requirements
REQUIRED REGISTRATION: Registration is required to be able to participate and receive the workbook.
REQUIRED WORKBOOK: The workbook will be mailed to you prior to the first class you attend. 
REQUIRED TECHNOLOGY: It is MANDATORY that participants use a laptop or desktop computer that has a working camera and that their video remain on during the class.
REQUIRED PROGRAMS: ZOOM 

>> Registration is open and FREE TO MAINE RESIDENTS ONLY. There are limited spots available and will be reserved on a first come first serve basis. Registrants must complete this online form or call/email Renée to register to reserve a spot.
>> Once registration is confirmed a ZOOM invitation and link will be sent to the email provided for the participant. 
>> A certificate of completion will be available to the participant once all classes are completed and exam done.

To register for a class or for any questions on Prime for Life and the other Prime for Life programs available please email Renée Mozeliak at renee.mozeliak@healthyacadia.org or call at (207) 801-8605
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Correo *
What is today's date?  *
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Who is filling out this form? (First & Last Name) *
Are you requesting this class for yourself or someone else? *
If you requested this class for someone else, please tell us the name of the person you are signing up. 
Then tell us your organization/business, or your relationship to the person. 
Phone number: *
Email Address: *
Mailing address: 
(Prime for Life requires a workbook which will be mailed to the address you provide.)
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What county are you in?
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