I understand that submitting this application does not secure a Learning Lab for my chapter.

Learning Labs are free for RIMS members and $50.00 USD for RIMS non-members.

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* 1. Chapter Name

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* 2. Which program would you like to choose?

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* 3. Applicant Name

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* 4. Phone Number

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* 5. Email:

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* 6. Preferred date(s) for chapter Learning Lab

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* 7. Preferred venue for chapter Learning Lab

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* 8. When does your chapter usually hold meetings (month/day/time)?

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* 9. Chapter Meeting Venue

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* 10. Total Chapter Members

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* 11. Average attendance at chapter meetings

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* 12. Other questions or comments 

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