Community Clinic Association of Los Angeles County

Enrollment Refresher Training – RSVP

Is your agency a cohort member of CPCA Health Navigator Project?*
- Yes
- No
Attendee Name*
First Last
Attendee Title*
Attendee Direct Phone*
Organization*
Scroll down to select your organization. Please note that all participating members that are part of CCALAC's cohort for the CPCA Health Navigator Project are listed in the drop down here.
Organization*
Scroll down to select your organization. Please note that non-cohort CCALAC Members & Affiliates are listed in the drop down here.
Attendee Email*
Enter Email Confirm Email
Cohort Registration*
Price:
Cohort Registration Quantity/Total Number of Registrants*
Please enter a number greater than or equal to 0.
At the bottom of the page, please list only the additional attendee(s). Do not include the first, above entry.
Non-Cohort Member & Affailiate Registration*
Price:
Non-Cohort Registration Quantity/Total Number of Registrants*
Please enter a number greater than or equal to 1.
At the bottom of the page, please list only the additional attendee(s). Do not include the first, above entry.
Total
$0.00
Payment Method*
- Credit Card
Send a copy of the receipt to:
Enter Email Confirm Email
Name As It Appears On Card:
Credit Card*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Send a copy of the receipt to:*
Enter Email Confirm Email
Subscribe to Training Center
By checking this box, I agree to be added to the Training Center mailing list.
Add more Attendees
First Name
Last Name
Attendee Title
Attendee Email

Main Menu ×

Community Clinic Association of Los Angeles County

Enrollment Refresher Training – RSVP

Reset Your Password