Take Control of Your Health
Notification of Upcoming Workshop

SUBMIT THIS FORM BEFORE WORKSHOP STARTS!

Site Name

Workshop Dates

Start Time

Address

City

County

Zip Code

Host Organization

Language (if other than English)

Peer Leader/Master Trainer 1

Telephone Number

Email Address

Peer Leader/Master Trainer 2

Telephone Number

Email Address

Peer Leader/Master Trainer 3

Telephone Number

Email Address

Program Type:

Chronic Disease Self-Management Program

Tomando Control De Su Salud

Diabetes Self-Management Program

Programa de Manejo Personal de la Diabetes

Cancer Thriving and Surviving Workshop (CTS)

Chronic Pain Self-Management Program (CPSMP)

Positive Self-Management Program for HIV

Workplace CDSMP

Building Better Caregivers (BBC)

Would you like to have this workshop marketed through the state listserv?

Yes No
If Yes, contact information for registration:
Submit to your Master Trainer or NJDHS at andrew.biederman@dhs.state.nj.us; Fax: 609-588-7630

ACS-17

DEC 19

ACS-17, TCYH Notification of Upcoming Workshop

ACS-17, ACS, Take Control of Your Health, notification, upcoming workshop

Windows User

2016-09-16

Dennis McGowan

HUMAN SERVICES