Registration Form: Applied Suicide Intervention Skills Training (ASIST) for Bergen County Faith Leaders

Registration Form: Applied Suicide Intervention Skills Training (ASIST) for Bergen County Faith Leaders

Hosted by Bergen's Promise and Bergen New Bridge Medical Center
Name

First NameLast Name
ASIST is a two-day interactive workshop that teaches participants how to recognize when someone may be at risk of suicide and how to help them create a plan to stay safe.

Training Details:

Date: Tuesday April 28th AND Wednesday April 29th

Time: 8:00 AM – 4:00 PM (both days)

Location: Bergen’s Promise, 3 University Plaza Drive, Suite 300, Hackensack, NJ 07601

Lunch and breakfast will be provided each day.
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Faith Community/House of Worship Name
Role/Title within Faith Community/House of Worship
Faith Community/House of Worship Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any dietary restrictions or allergies?
If so, please specify
NoneASISTsafeTALKMental Health First Aid (MHFA)Question. Persuade. Refer. (QPR)Other
I understand this is a 2-day training 8am-4pm. I understand that by registering I am committing to attend both days.

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