Kno'Qoti Native Wellness, Inc.
422 South Main Street, Lakeport, CA 95453
www.knwi.org
(707) 900-2121
Training/Workshop Request Form
Please fill out the form below, and a member of our team will contact you to coordinate the next steps.
Name of Hosting Tribe or Organization
*
Training/Workshop Start Date
-
Month
-
Day
Year
Date
Training/Workshop End Date
-
Month
-
Day
Year
Date
Hours of Training/Workshop (Start & End Time)
Start Time
AM
PM
AM/PM Option
to
until
End Time
AM
PM
AM/PM Option
Total 0.0
Additional information about the duration of the workshop we should know about
Name of Hosts Main Point of Contact (HMPC)
*
First Name
Last Name
Email of HMPC
*
example@example.com
Phone Number for HMPC
*
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Training/Workshop Details
How will the training session be held?
At a Physical Location
Virtually
In a Hybrid Format
Event Location (If training session being held only virtually, you may leave blank)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who will be attending this Training/Workshop? (Check all that apply)
*
Staff
Youth
Adults
Elders
Families
Other
How many people do you anticipate?
*
What are the key goals that your organization hopes to achieve through this training or workshop?
What specific outcomes or achievements would your organization consider to be indicators of a successful training or workshop?
Anything else we should know?
Submit Form
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