Registration

Emerge Course Registration

Please fill out all the information below. If you have any questions about registration, please call or e-mail our office. Upon receiving your registration, we will mail you a confirmation letter, directions and maps as well as further instructions, if applicable. Your registration may take up to two weeks to process, and if registering less than two weeks before a training, you may not get a mailed confirmation letter, although we may be able to e-mail one if desired. If you wish to mail in a payment, print your registration before submitting and send a printed copy with a check or money order.

You must submit a separate registration form for each attendee, and a separate registration for each training you plan on attending.

Course:
Last Name:		First Name:
Job Title:		Agency / Company / Organization:
Address:
City:	State:		Zip Code:
Phone:		E-mail:
Payment Method:
*Did you or a colleague receive an Emerge training brochure in the mail?*
Where did you hear about this training and/or Emerge?
Notes / Questions:

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© Emerge: Counseling & Education to Stop Domestic Violence

2464 Massachusetts Avenue, Suite 101

Cambridge, MA 02140

617-547-9879 ~ 617-547-0904(f)

emergedv@aol.com