Register to Host - Infant Adoption Training Initiative

Contact Information

First Name:	Last Name:
Title:
Email Address: EX: you@organization.com No caps or spaces in the email
Best way to reach you Phone Email Mail	Best time to call: Morning Afternoon Evening
Organization / Facility

Organization / Facility:
Facility Classification:
Address:	City:
State:	Zip:
Phone:	Fax:
Training Date

List three choices for dates that would work for you. 1. 2. 3.
What is the maximum number of participants your site can accomodate?:
Do you want your traing to be open to others in the community or exclusive to staff in your clinic/center?: open to others staff only
If opening it up to others, how many slots do you want to reserve?:
Question or Comment

What trainees are saying ...

Thank you so much for a wonderful opportunity to learn about "adoption as an option." It is definitely worth giving three days to this training.

-Adoption Specialist,
New York