Canadian Mental Health Association - Kawartha Lakes Branch

Registration Form
Applied Suicide Intervention Skills Training - A.S.I.S.T.

A.S.I.S.T. is a 2 day, interactive training program regarding suicide first aid. During
these 2 days you will learn how to utilize a adaptable model for intervening with a
suicidal individual that is taught and recognized world wide.

If you have a physical disability, please inform us so that an alternative location can
be arranged.

Name:

Organization:

Contact information:

Phone:
Fax:
Email:

Mailing Address:

Have you attended an A.S.I.S.T. program in the past?

Yes

If yes, when?

Training Dates preferred: