Registration Form For Asist

Registration Form for ASIST Alaska ASIST Trainers Date of Workshop: _____________________________ Location of Workshop: __________________________ Name __________________________________________________ Mailing Address ________________________________________________________ ________________________________________________________ Contact Information Phone ___________________________________________________ Email ___________________________________________________ Any special dietary requirements ______________________________

Please include a deposit of $50.00 payable to GreyWolf Consulting LLC. Mail to: GreyWolf Consulting LLC 1615 Halibut Point Road #6 Sitka, AK 99835 The balance of $175 is due at the start of the workshop. Deposits are refundable until _____________________. Additional information about time and location will be sent on receipt of your deposit. We look forward to working with you. Thank you for your interest in suicide prevention. Iva GreyWolf 907-738-7604 (cell) 907-747-3453 (fax)