To Whom I May Concern® Facilitator Training Fall 2023

To Whom I May Concern® Facilitator Training

Fall 2023
- Day 1: Wednesday, November 15, 2023, 11 am - 2 pm ET
- Day 2: Wednesday, November 29, 2023, 11 am - 2 pm ET
- Day 3: Thursday, November 30, 2023, 11 am - 2 pm ET
Personal Information
Full Name*

PrefixFirst NameLast Name
Organization
Your Position
E-mail*
Phone Number*

Area CodePhone Number
Mobile Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please help us get to know you by telling us about your experiences
Do you currently or have you previously facilitated a support group for people living with dementia?

YesNo
Please tell us about your experience facilitating a support group or other group involving people living with dementia:
Do you plan on holding a To Whom I May Concern® performance in your community within 6 months of the training?

YesNo
Use this field to tell us anything you think would be helpful to us about your plans for To Whom I May Concern in your community and/or your current work with people living with dementia.
Additional Trainees from the Same Organization

If you would like five or more people from your organization who would like to take the training together, please contact laura@towhomimayconcern.org to arrange for a private training session.
1st Additional Trainee

PrefixFirst NameLast Name
Position
E-mail
2nd Additional Trainee

First NameLast Name
Position
E-mail
3rd Additional Trainee

First NameLast Name
Position
E-mail
example@example.com
Payment
Please choose one of the following payment options:*

Invoice my organizationPayment via PayPal
If you would like us to invoice your organization, please submit the company name and contact information below.

Please choose one of the following options. Payment is processed through PayPal.

Registration Fee:$750.00

Registration Fee (2 trainees from same organization):$1,350.00

Registration Fee (3 trainees from same organization):$2,025.00

Registration Fee (4 trainees from same organization):$2,700.00

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Total $0.00

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