STOP VAIW January 20, 2009 Phone Training
REGISTRATION FORM
The questions marked with "
*
" requires an answer.
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Grant number:
Grant number:
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Organization :
Organization :
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City:
City:
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State:
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DE
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GU
HI
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State:
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Zip:
Zip:
Please provide Email address for Registration confirmation and/or handouts.
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Email address:
Email address:
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Phone Number:
Phone Number:
Fax number:
Fax number:
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Name:
Name:
*
Occupation :
Batterer intervention program staff
Corrections personnel (Probation/offender monitor)
Court personnel (judge, clerk)
Domestic violence program staff
Dual sexual assault and domestic violence program staff
Law enforcement officers
Prosecutors
Sexual assault program staff
State, tribal and/or territory sexual assault coalition and/or domestic violence coalition
Tribal government/Tribal government agency staff
Victim-witness specialists
Other (please specify)
Occupation :
Please use the following boxes to register additional participants.
Note
: The registration confirmation and/or handouts will be only sent to the email address you have entered in the box above.
Name:
Name:
Occupation :
Batterer intervention program staff
Corrections personnel (Probation/offender monitor)
Court personnel (judge, clerk)
Domestic violence program staff
Dual sexual assault and domestic violence program staff
Law enforcement officers
Prosecutors
Sexual assault program staff
State, tribal and/or territory sexual assault coalition and/or domestic violence coalition
Tribal government/Tribal government agency staff
Victim-witness specialists
Other (please specify)
Occupation :
Name:
Name:
Occupation :
Batterer intervention program staff
Corrections personnel (Probation/offender monitor)
Court personnel (judge, clerk)
Domestic violence program staff
Dual sexual assault and domestic violence program staff
Law enforcement officers
Prosecutors
Sexual assault program staff
State, tribal and/or territory sexual assault coalition and/or domestic violence coalition
Tribal government/Tribal government agency staff
Victim-witness specialists
Other (please specify)
Occupation :
Name:
Name:
Occupation :
Batterer intervention program staff
Corrections personnel (Probation/offender monitor)
Court personnel (judge, clerk)
Domestic violence program staff
Dual sexual assault and domestic violence program staff
Law enforcement officers
Prosecutors
Sexual assault program staff
State, tribal and/or territory sexual assault coalition and/or domestic violence coalition
Tribal government/Tribal government agency staff
Victim-witness specialists
Other (please specify)
Occupation :
Name:
Name:
Occupation :
Batterer intervention program staff
Corrections personnel (Probation/offender monitor)
Court personnel (judge, clerk)
Domestic violence program staff
Dual sexual assault and domestic violence program staff
Law enforcement officers
Prosecutors
Sexual assault program staff
State, tribal and/or territory sexual assault coalition and/or domestic violence coalition
Tribal government/Tribal government agency staff
Victim-witness specialists
Other (please specify)
Occupation :
Name:
Name:
Occupation :
Batterer intervention program staff
Corrections personnel (Probation/offender monitor)
Court personnel (judge, clerk)
Domestic violence program staff
Dual sexual assault and domestic violence program staff
Law enforcement officers
Prosecutors
Sexual assault program staff
State, tribal and/or territory sexual assault coalition and/or domestic violence coalition
Tribal government/Tribal government agency staff
Victim-witness specialists
Other (please specify)
Occupation :
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