New Jersey Prevention Network
WISE Follow-Up Form

Thank you for your interest in attending an upcoming WISE Facilitator Training.

Please fill out the following information to be added to the Wait List for the next WISE Facilitator Training.

* Required Field

* Organization Name

* Street

Street 2

* City

* State

* Zip Code

* Primary Phone

* Primary E-mail:

* Confirm Primary E-mail:

* Please note that the WISE curriculum must be facilitated by 2 people

* First Name

* Last Name

* Position/Title

* Phone

* E-mail

* Confirm E-mail

* I am or Are you interested in Attending Courses?

* Are you Interested in more information?

Please note future trainings are announced via email, please ensure Emily@njpn.org is allowed through your email provider.