Network Meetings Registration Form

Which network meeting will you attend 

 

Name
Organization
Title
Address
City
State
Zip
Phone
Fax
Email

The American Lung Association of NC can provide hotel accommodations for you if:

  • You are traveling more than 100 miles to attend the training (the night before the training only)

  • You are attending two days of training (the night of day one)

  • You meet both above requirements (the night before and the night of day one)

Do you qualify for accommodations? Yes        No

Lunch will be provided.    Please indicate your preference:  Regular    Vegetarian 

Other Needs:    
                           (please, medical or religious needs only)

Are you a North Carolina Health and Wellness Trust Fund Grantee?Yes    No

There is no charge for the Facilitator Network Meetings

You will receive a confirmation email or letter from Demetrius Harvey prior to the training that includes, directions, agenda, and any other information you need.

Contact us at1-800-LUNG-USA with any questions!