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    Contact Information
First Name:
 Last Name:
Title:
Email Address:
EX: you@organization.com
No caps or spaces in the email
Best way to reach you
Phone   Email   Mail 		Best time to call:
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    Organization / Facility
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    Training Date
List three choices for dates that would work for you.
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What is the maximum number of participants your site can accomodate?:
Do you want your training to be open to others in the community or exclusive to staff in your clinic/center?:
open to others       staff only
If opening it up to others, how many slots do you want to reserve?:
    Question or Comment
   

What trainees are saying ...

Thank you so much for a wonderful opportunity to learn about "adoption as an option." It is definitely worth giving three days to this training.

-Adoption Specialist,
New York