* 1. First Name:

* 2. Last Name:

* 3. Title:

* 4. Organization:

* 5. Email Address:

* 6. Telephone Number:

* 7. Select Session One (9:15-10:45 a.m.) Refer to agenda for details.

* 8. Select Session Two (10:55 a.m. - 12:15 p.m.) Refer to agenda for details.

* 9. Select Lunch Option

10. Select Interactive Round-table Sessions (2:45 - 4:15 p.m.) Refer to agenda for details. PLEASE CHOOSE SIX. While you will attend only three sessions, maximum participation of each session is 12 attendees. We will enroll these sessions on a first-come, first-served basis.

11. How did you hear about this training opportunity? Please indicate specific information (who told you, what listserv, what Facebook page, etc.)

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