For Trained Trainers to report trainings in Lenawee, Livingston, Monroe and Washtenaw counties.

Please log any trainings you've given in the community since you've completed the Naloxone Train the Trainer course with Dr. Gina Dahlem.

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* 1. Trainer Name:

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* 2. Trainer Email:

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* 3. Training Date:

Date

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* 4. Number of Individuals Trained:

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* 5. County of Training:

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* 6. Type of Training:

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* 7. Number of Naloxone Distributed (at this training):

T