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Preconception Peer Educators (PPE): Training Registration

NOTE: There is a limit of 100 students per training site. If the registrations exceed the number of available spots, students will be placed on a waiting list on first come first serve basis. If a student is unable to attend, we appreciate being notified, so we can release that registration. We will notify waiting list students if they are not able to attend the training. A field with an asterisk () before it is a required field.*

*	First Name:
*	Last Name:
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*	College/University:
	Current Address:
*	Email:
*	Phone:
*	Select Training Location (Note: This has to be the city and state where you go to school. Ask your advisor if you are not sure.)

Office of Minority Health
Toll Free: 1-800-444-6472 / Fax: 301-251-2160
Email: info@minorityhealth.hhs.gov

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