This form is intended for CMHM Champions, local Behavioral Health Providers, and members of child serving organizations to request to host a training or presentation at a CMHM Monthly Webinar.

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1. Contact Name (Required.)

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3. Phone

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4. Champion name if applicable (ex: name of school, business or organization)

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5. I would like be a presenter for the CMHM Monthly Webinar on the following topic.

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6. The following dates are open to host a presentation or training. Please select all dates you are available.

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7. Can your presentation be recorded and shared on the CMHM website?

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8. Can your presentation slides be shared with Webinar registrants and on the CMHM website?

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9. Please share any additional questions or comments.

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