IDL Responders Training Request Form

Name *

First

Last

Gender

Email *

Telephone Number *

Organization you represent *

Address of your organization - street, city, and country *

Telephone of organization *

Your Job Title or Position *

Method of training presentation *

Number of persons to be trained. The limit is 20-50. State the number *

Proposed beginning and end dates to cover a five-week period *

Workshop venue for face-to-face presentations

Counseling venue for face-to-face sessions

Comment, message, or special request regarding the training

Name