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Which course will you be attending?
*
March 18 (8AM - 11AM) & March 25 (8AM - 11AM)
April 22 (9AM - 12PM) & April 23 (9AM - 12PM)
Please fill out the information below for the person attending the course (participant).
First Name
*
Last Name
*
Email Address
*
Organization
*
Title
Address 1
*
Address 2
City
*
State
*
Zip Code
*
Phone Number
*
Sector Type?
*
Consulting/Professional Services
Corporate/Private Business
Education High Ed
Education K-12
Government City/County/Regional
Government Federal
Government State
Healthcare/Medical
Non Profit/Community Based Org
Philanthropic Foundation
Professional Trade Association
Religious/Faith Based Org
Other
How did you find out about this course?
*
Referral - employer/colleague/friend
Internet/Online Search
HueLife Website
ICA Website
Facebook
LinkedIn
HueLife Email
Brochure or Flyer
Event
Community of practice event
Findcourses.com
Other
Referral Name
Referral Email or Phone Number
Event Name
Please provide some detail
We'd like to understand the role you play in your organization:
I Facilitate
*
1-2 Times a year
1-2 Times a quarter
1-2 Times a month
3-5 Times a month
More than 5 times a month
Role in organization
*
Manager/Executive/Director
Supervisor/Team Leader
Project Manager/ TQM Manager
Planner
Facilitator/Trainer
Educator
Human Resources
Community Development
Public Health Practitioner
Other
Coupon code
Do you need an invoice?
*
Yes
No
Upon arriving at the forms payment page, please choose
"pay by check"
to submit the form without providing payment at this time.
For questions or concerns please contact:
Irina Fursman
Phone: 763.232.2338
Email: irina.fursman@hue.life