Nuci Phillips Memorial Foundation · Individual Sign Up for QPR Training Hosted @ Nuçi's Space

Contact Information

Name *

First Name

Last Name

Pronouns

Email *

Verify Email *

Phone *

County of Residence *

Which of the following dates would you like to attend? *

Note: November 1st session is full.

Dec 11th - 9:00a - 11:30a

English and Spanish official QPR booklets are available - handouts/graphics and presentation will be in English. *

Please select official booklet language version:

English

Spanish

Age Verification *

Per QPR Institute guidelines, attendees must be at least 18 years of age. Potential attendees acknowledge:

I am 18 years of age or older.

I am NOT 18 years of age or older. I would like to learn more about QPR training for individuals under the age of 18.

How did you hear about us? *

Any other notes?