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

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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 serve as a host for a training or presentation. Please indicate all dates that you are available to host.
Webinars are each 3rd Thursday of the month, 11:30 AM - 12:30 PM

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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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