Registration form for Leader Training

March 20, 2019
9:00 a.m. to 5:00 p.m.

Redwood Area Community Center
Room 3B
901 E Cook Street
Redwood Falls, MN 56283


Registration is due with payment by February 27, 2019.
The cost of the training is $70 (this includes lunch and refreshments).

You can either pay by Paypal or check. 
You can pay with PayPal on the "Become a Leader" tab on this page.

Checks can be made out to MNRAAA and mailed to:
Kelly Wolle
Minnesota River Area Agency on Aging
201 N. Broad St., Suite 102
Mankato, MN 56001

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* 1. Leader's Contact Information

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* 2. Have you completed CDSMP/Living with Chronic Conditions leader training?

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* 3. What was/is the start date of the most recent CDSMP/Living with Chronic Conditions class you lead?

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* 4. Please identify individual(s) you will be working/coordinating with to offer workshops.

Please Note: All classes require two trained leaders. Leaders must attend both days of training if you don’t already have a certified co-facilitator.

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* 5. Sponsoring Organization:

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* 6. Please identify the communities where you plan to implement DSMP Class:

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* 7. Do you require any special accommodations?

Leader agreement: You cannot teach the course until you have attended all four days of the training. You must teach a complete class series within 6 months of receiving your initial training. Please notify the MNRAAA office with your class dates prior to holding classes.

I agree to teach one entire DSMP/Living Well with Diabetes course within 6 months. I will teach in strict accordance with the course as written in the Leaders Manual, and as taught to me at leaders training. I will attend all four days of the leaders training. I will notify MNRAAA prior to holding classes.

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* 8. We've recently changed how we contact our partners about Program Development updates, future training opportunities and news.
To receive emails with our new system, you will need check the box for the emails that you like to receive from us.

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* 9. (By entering your name in the box below, you agree to the terms of the leader agreement.)

For more information, contact:

Kelly Wolle

Administrative and Communications Assistant
Minnesota River Area Agency on Aging
201 N. Broad St., Suite 102
Mankato, MN 56001

kwolle@mnraaa.org
507.387.1256   x102
Fax: 507.387.6223

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