Community Health Improvement Coalition

October 10, 2019

Online Registration Form

Pre-registration is required.

Registration Fee includes light breakfast, lunch and snacks.
General Public: $10.00
Professional Development CEU & TCOLE:
Early Bird Registration ends 9/25/2019: $40.00
     (After the 25th, CEU registration: $50.00)

             Change these
  values as needed


I have read the information provided for the event and certify my signature and monetary obligation by selecting ACCEPT.   

After Submitting this registration form and viewing the confirmation page, click the left arrow (back button) to return to this page to enter additional registrations or make your payment.
You may Submit several registrations before making the payment. You may return to this Web page just to make a payment.
The registration data will be compared to the payment data, so be sure to make your payments.


You may pay by check:
Make checks payable to CHIC
With a MEMO: (the line at the lower left of the check) of Mental Health, or MH Training, or something that includes MH.
Mailed to:
PO BOX 421657
DEL RIO TX 78842-1657

In the Other Information block of the registration form you should have "paying by check number ####"
Along with your check include in your letter; printed filled out registration form(s) from the registration Web page.
Or you can use either a copy of the conformation Web page form or a copy of the conformation e-mail page.
Or just print the blank registration form page and fill it out.

You may pay from PayPal by credit card or using the PayPal process:
Because we are a nonprofit organization the payment button below is labeled Donate.
When you click on the Donate button for payment you will be directed to the PayPal Web site. If you are using a credit/debit card to make a payment the PayPal Web site is where you will fill in the required information.

Thank You!