LAC Workshop Registration

Please supply your contact information, select the workshop you want to attend, then click 'Submit Registration'.

First Name

Middle Initial

Last Name

Organization

Job Title

Address

City

State

ZIP Code

Email

Phone

Security Code

Please enter the word you see in the image below:

Select Workshop

NO WORKSHOPS CURRENTLY SCHEDULED...

Primary Work Setting	Family Planning/PCAP Health Center CBO/Community Agency Alcohol/Drug Treatment Program Non-Institutional Nursing Services Child Welfare Services/Foster Care Health Department Educational Institution AIDS Treatment Center EMS/Police/Fire Correctional Facility/Jail Mental Health Services Hospital Physician's Office/Lab Nursing Home/Adult Day Care Other
Primary Occupation	COBRA - CM/CMT COBRA - CFW Social Worker/Case Manager Community Educator/Outreach Worker Nurse Administrator Nurse Practitioner/Physician's Assistant Teacher/Trainer/Student HIV Test Counselor Physician MR/MH Worker Criminal Justice/Law Enforcement Counselor/Therapist Emergency Personnel Domestic Violence Provider
Education Level	Less than 12 Years of Education High School/GED College: 1 Year 2 Year 3 Year 4 Year Graduate Degree
Ethnicity	Hispanic or Latino(a) Not Hispanic or Latino(a)
Number of Years In Current Occupation	0 - 1 2 - 4 5 - 7 More than 8
What County Do You Work In The Most?
Race	American Indian or Native Alaskan Asian Black or African American Native Hawaiian or Pacific Islander White