Registration

Space is limited in all classes. To secure your registration, please submit the registration form as early as possible.

You may register online below or download the registration PDF, and send it to the address/fax location indicated on the form.

 

 

Please enter the following information:

First Name:
Last Name:
Agency:
Street Address :
County:
City:
State:
Zip Code:
Daytime Phone:
Fax:
E-Mail:
Primary Work Setting:	AIDS Treatment Center Alcohol/Drug Treatment Program CBO/Community Agency Child Welfare Services/Foster Care Correctional Facility/Jail Educational Institution EMS/Police/Fire Health Center Health Department Hospital Mental Health Services Non-Institutional Nursing Services Nursing Home/Adult Day Care Physician's Office/Lab Other - Please Specify
Other:
Primary Occupation:	Administrator COBRA CM/CMT/CFW Community Educator/Outreach Worker Counselor/Therapist Criminal Justice/Law Enforcement Domestic Violence Provider Emergency Personnel Family Planning/PCAP HIV Test Counselor MR/MH Worker Nurse Nurse Practitioner/Physician's Asst. Physician Social Worker/Case Manager Teacher/Trainer/Student Other - Please Specify
Other:
Education Level:	Less than 12 years High School/GED College - 1 year College - 2 years College - 3 years College - 4 years Graduate Degree - MS Graduate Degree - MA Graduate Degree - MSW Graduate Degree - MSN Graduate Degree - MD Graduate Degree - PhD
Ethnicity:	Not Hispanic or Latino(a) Hispanic or Latino(a)
Race:	White Black or African American Asian American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Unknown/Unreported Other - Please Specify
Other:
Number of Years in Current Occupation:	0-1 2-4 5-7 8 plus
Now, indicate your selections by clicking on the appropriate check boxes.

Training Title	Check Box	Location	Date(s)
Addressing Sexual Risk with Active Drug Users and Their Partners		Clinton County Government Center, Plattsburgh, NY	July 8 8:30am to 4:30pm
		PDP Training Center, Albany, NY	Sep 15 8:30am to 4:30pm
HIV/AIDS Confidentiality Law		Clinton County Government Center, Plattsburgh, NY	Jul 9 8:30am to 12:00pm
		Fulton County Government Center, Johnstown, NY	Sep 14 10:00am to 1:00pm
Addressing Prevention in HIV Case Management		PDP Training Center, Albany, NY	Aug 26 8:30am to 4:30pm
Improving Health Outcomes for HIV-Positive Individuals Transitioning from Correctional Settings to the Community		Washington County Public Health, Ft. Edward, NY	Sep 2 8:30am to 4:30pm
HIV Testing in NYS: Guidance		PDP Training Center, Albany, NY	Sep 9 8:30am to 12:00pm
HIV Testing Skills: Practice Session		PDP Training Center, Albany, NY	Sep 10 8:30am to 4:30pm
HIV and Hepatitis C Coinfection		PDP Training Center, Albany, NY	Sep 16 1:00pm to 4:00pm
Sex, Gender and HIV		PDP Training Center, Albany, NY	Oct 7 & 8 8:30am to 4:30pm
		Washington County Public Health, Ft. Edward, NY	Oct 21 & 22 8:30am to 4:30pm
Substance Use and HIV/AIDS: Improving Outcomes in Case Management Service Provision		Binghamton NY	Oct 14-15
Group Facilitation Skills for HIV/STD Prevention Intervention		PDP Training Center, Albany, NY	Dec 9 & 10 8:30am to 4:30pm
VOICES/VOCES		PDP Training Center, Albany, NY	Dec 16 & 17 8:30am to 4:30pm

 

 

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