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* 1. Please enter the following

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* 2. Training Date & Time (please indicate whether fixed or flexible)

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* 3. Duration of training (hours)

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* 4. The following will be available for training use

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* 5. Number of participants expected

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* 6. Type of gatekeeper training requested

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* 7. If requesting a training for youth, select appropriate option (if not, please skip)

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* 8. Please specify any special requests/accommodations needed or anything else we should know.

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* 9. Please let us know how you heard about our trainings.

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