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register to host a training


    Contact Information
First Name:
 Last Name:
Title:
Email Address:
EX: you@organization.com
No caps or spaces in the email
Best way to reach you
Phone   Email   Mail 		Best time to call:
Morning     Afternoon     Evening
    Organization / Facility
Organization / Facility:
Facility Classification:
Address:
 City:
State:
 Zip:
Phone:
 Fax:
    Training Date
List three choices for dates that would work for you.
1.
2.
3.

What is the maximum number of participants your site can accomodate?:
Do you want your traing to be open to others in the community or exclusive to staff in your clinic/center?:
open to others       staff only
If opening it up to others, how many slots do you want to reserve?:
    Question or Comment
   
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Latino Family Institute