(BY INVITATION ONLY) Stategic Prevention Framework Training

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Location: Montpelier, VT
Dates: May 11, 2010
Times: 8:00am – 9:00am Registration and Continental Breakfast
9:00am – 4:00pm Training
Cost: These trainings, by invitation only, are funded through grants from the Vermont Department of Health.

Participant materials, continental breakfast and lunch will be provided.

Participants are encouraged to bring water bottles in order to save on consumables. Prevention Consultants, please bring easels.

Please fill out the following information.

Participant Information:
Title	First name	Last name

Email Address

Email Address (again)

Organization or School Information:
Organization

School
(Pick 'none' if this doesn't apply.)
Other School

Other Supervisory Union

Street Address Line 1

Street Address Line 2 (Optional)

City

State	Zip

Work Phone Number

Work Fax Number

NOTE: So we can contact you in the event of cancellation, please provide your home phone number:
Home Phone Number (Please see note above)

Personal Information:
Organizational Role

Other Organizational Role

How did you hear about this training?

Other way you heard about this training if not in list above.

Please complete the following pre-assessment questions:
Please identify your Prevention Consultant. If you don't know, type "I do not know".