To enroll in this training session and reserve your spot, please complete this form and email it to Kristy Roosa at kristy.roosa@idph.iowa.gov  Send payment, made out to the Iowa Dept. of Public Health, to the following address: IDPH, MIECHV Program c/o Kristy Roosa 321 East 12^th Street, Des Moines, Iowa 50319.  You may also pay for training the day of during registration. Please note if you are unable to attend, a full refund will be available up to 48hrs prior to the date of the training. If cancelling within 48hrs, you will no longer be eligible for a refund. Please notify me if you have registered and will no longer be able to attend as that may allow another person to enroll.

Please * names of any supervisors attending. Thank you!