Training and Presentation Request Form

Training and Presentation Request Form

Thank you for considering the Brain Injury Association of Maryland for your training needs. Please complete this form to request a presentation. Someone from our organization will contact you within two business days to follow-up on your request. The topics provided below are suggestions based on common requests. We would also be happy to customize a training to meet your needs. Please note we are a provider for Maryland Board of Social Work, and can offer Continuing Education Units for Social Workers, LCPC, and Psychology. All trainings are free.
Name

First Name Last Name
Organization
Job Title
Email
example@example.com
Phone Number
Please enter a valid phone number.
Training Topics (all trainings require at least 60 minutes)

Brain Injury 101 Brain Injury and Mental Health Brain Injury and PTSD Brain Injury and Aging Safefy Brain Injury and Substance Use Disorder
Certificate Training

Brain Injury Fundamentals (12 hour training)
Credential Training

Certified Brain Injury Specialist (12 hour training). There is a fee associated with this training, please contact us for details.
Didn't find what you need? What custom brain injury topic are you interested in?
What would be beneficial for BIAMD to cover over the course of the training? What are some frequent barriers your department comes across?
What is your base or background knowledge of brain injury?
Date of Requested Presentation (please give us 30 days notice, if possible)

Month Day Year
Date
Start Time of Requested Presentation

Hour Minutes

AM/PM Option
Would you prefer an in-person training or virtual training?

In Person Virtual
Approximate Audience Size
How did you hear about us?

BIAMD Website Attended Previous Presentation or Event From Another Organization From a Colleague or Friend Other
Is there anything else you would like to share with us?
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