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* 1. Contact Name

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* 2. Organization (if applicable)

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* 3. Contact Email address

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* 4. Contact Phone number

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* 5. I am interested in setting up a

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* 6. I am requesting a two day format.  Schedule the 2 sessions no more than a week apart. (Please allow a minimum of 30 days notice.)

Date / Time
Date / Time

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* 7. I am requesting a one day format. (Please allow a minimum of 30 days notice.)

Date / Time

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* 8. A class must have a minimum of 10 and may have a maximum of 25 participants (space permitting). Note that participants must be 18 years or older.

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* 9. Can you provide training space? (The class requires room for separate tables of four to five participants each with enough room to move around.)

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* 10. Several pieces of equipment are needed for the training. Please indicate which you can provide:

T