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2277 Highway 36 West, Suite 200 Roseville, MN 55113-3830
Phone: 612-378-2742
Toll Free: 1-800-669-6442
Fax: 612-378-2789
E-Mail:info@braininjurymn.org
Hours: Monday-Friday, 8 a.m. to 4:30 p.m.

Education Registration

Education Registration for Minnesota Brain Injury Alliance Classes and Wednesday Workshop

To register for any of the Brain Injury Basics, Education Training Sessions, or Wednesday Workshops, please fill out the form below. To schedule a training at your facility, please call the Education Department at 612-378-2742 or 800-669-6442. You may register for only one class at a time, and may include up to five participants per registration.

Contact Information
Organization:
Address:*
City:*
State:*
Zip:*
Daytime Phone:*
Evening/Cell Phone:
Fax:
E-mail:*
Class/Workshop Participants
Participant #1:*
Participant #2:
Participant #3:
Participant #4:
Participant #5:
Please select which class you are registering for
Class and date:*
Payment Options:
Payment Method:*

If you wish to pay with a Visa or MasterCard credit card, please submit this registration form, then call us at 612-378-2742 or 800-669-6442 to process your billing information. You may still use this form to register.
Invoice address:
Organization:
Address:
City
State
Zip
Total Due
  • A $5 donation is appreciated from individuals with brain injury, family members and friends; the fee per session is $25 for professionals.
  • Wednesday Workshops are $40 per person, per session. Wednesday Workshops are geared towards professionals
Total Due: $ (please fill in)

           
Please call 612-378-2742 or 800-669-6442 with any questions. Thank you.