Roundtable Registration Form

ICDVVA Regional Roundtable & Training Registration Form

Hosted by the Idaho Council on Domestic Violence and Victim Assistance
Name *

First Name Last Name
E-mail *
example@example.com
Job Title *
Organization *
Is your organization currently funded by ICDVVA? *

Yes No
Please indicate which Roundtable Training you will be attending: *

Region 1: May 3rd, 2022 @ 1st CASA, Coeur d'Alene Region 2: September 13th, 2022 @ YWCA, Lewiston Region 3: August 24th, 2022 @ Nampa Public Library, Nampa Region 4: November 17th, 2022 @ TBD Region 5: June 28th, 2022 @ Twin Falls County Annex, Twin Falls Region 6: August 3rd, 2022 @ ISU, Pocatelo Region 7: August 2nd, 2022 @ Bonneville County Sherriff's Training Center, Idaho Falls
Please indicate which Roundtable you will be attending: *

Region 1: May 3rd, 2022 @ 1st CASA, Coeur d'Alene Region 2: September 13th, 2022 @ YWCA, Lewiston Region 3: August 24th, 2022 @ Nampa Public Library, Nampa Region 4: November 17th, 2022 @ TBD Region 5: June 28th, 2022 @ Twin Falls County Annex, Twin Falls Region 6: August 3rd, 2022 @ ISU, Pocatello Region 7: August 2nd, 2022 @ Bonneville County Sherriff's Training Center, Idaho Falls
For funded programs, the morning session is required but the afternoon training is not. Please indicate if you plan on attending all day, or just the morning: *

Morning session only All day
Please let us know of any accessibility accommodations:
Should be Empty:

ICDVVA Regional Roundtable & Training Registration Form