Public Health Detailing Institute 2023 Registration

Attendees

Please enter the contact information for the TWO members of your detailing team who will be attending the training. Typically, one member should be the planned Detailer and the other should be someone who will be managing the Detailing program. If your program has participated in a prior Public Health Detailing Institute, we can accept 1 or 2 trainees.

Question Title

* 1. Please enter the contact information for the planned Detailer

Name

Health Department

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Please enter the information for the Detailing Program Manager

Name

Health Deparmtent

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number