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Training Request Form
Thank you for your interest in being trained by staff from ACR Health's Center of Expertise. Please complete and submit the training request form. Once the training department has reviewed your request, you will be contacted with further details or questions. Please allow 3-5 business days for review.
Name of Agency
*
Primary Contact
*
Agency Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Country
Email
*
Phone Number
*
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Area Code
Phone Number
Type of Organization
*
Please describe the audience
*
Area of Interest (Select One)
*
Please Select
Harm Reduction
Overdose Reversals
Substance Use
Topics of Interest (Select One)
*
Please Select
Opioid Overdose Reversal
Improving Healthcare With PWUD
Safer Injection & Wound Care
Harm Reduction 101
Supervising Staff & Peers WUD
Working With Pregnant PWUD
Empowering PWUD
Substance Use 101
Please provide any comments about the training topic(s) you are interested in:
Proposed Date 1
*
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Month
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Day
Year
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Proposed Date 2
*
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Month
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Day
Year
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Proposed Date 3
*
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Month
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Day
Year
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Begin Time
*
Hour Minutes
AM
PM
AM/PM Option
End Time
*
Hour Minutes
AM
PM
AM/PM Option
Will you provide the webinar platform? (If yes, please add the platform you will provide us)
*
Submit
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