Strategic Crisis Leadership: Bruce Blythe Survey

Thank you for taking the time to register for the Strategic Crisis Leadership Seminar featuring Bruce Blythe being held on April 25, 2012. Registration will be held from 9:30-10:00am. The course will begin promptly at 10:00am and conclude at 3:30pm. This program will be held at the Crowne Plaza Hotel located at 260 Mall Blvd, King of Prussia, Pa 19406.

If you have any questions or need additional information, please contact Edward Wurster at ewurster@separtf.org.

1. Please complete the following:

Please complete the following: Name:
Agency:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:

2. Please indicate the Regional Task Force Work Group which you belong:

Please indicate the Regional Task Force Work Group which you belong: Critical Infrastructure

Fire Fighting, US&R, Hazardous Materials

Human Services

Interoperable Communications

Private Sector Outreach & Coordination

Public Health, Hospitals, and EMS

Public Information

Public Safety & Security

Public Works, Engineering, & Transportation

Schools

Regional Task Force Executive Board

Regional Task Force Staff

I do not belong to a specific work group, but am interested in receiving additional information

3. Please indicate any accommodations that would allow us to best assist you while attending the course:

Please indicate any accommodations that would allow us to best assist you while attending the course: Language Interpretation

ASL Interpreter

Diet Restrictions (Please describe below)

Other (Please describe below)

Additional details/Other:

4. Please list any suggestions you may have for this or future programs:

Please list any suggestions you may have for this or future programs:

5. Agreement to Terms:

I acknowledge it is the policy of the Southeastern Pennsylvania Regional Task Force to provide availability for attendance in courses based on minimum and maximum enrollment requirements and that I must attend a course that I have registered, unless I provide notification 72 hours prior to the start of the course. I understand if I or my authorizing supervisor does not cancel participation in the course 72 hours prior to the start of the course then administrative sanctions may be levied up to and including prohibition from registering from courses for one year.

Agreement to Terms: I acknowledge it is the policy of the Southeastern Pennsylvania Regional Task Force to provide availability for attendance in courses based on minimum and maximum enrollment requirements and that I must attend a course that I have registered, unless I provide notification 72 hours prior to the start of the course. I understand if I or my authorizing supervisor does not cancel participation in the course 72 hours prior to the start of the course then administrative sanctions may be levied up to and including prohibition from registering from courses for one year. Yes, I agree with the terms.

No, I do not agree to the terms.

Strategic Crisis Leadership: Bruce Blythe
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Strategic Crisis Leadership: Bruce Blythe
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