Until Help Arrives Community Group Training Request

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* 1. Name of Group

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* 2. Point of Contact (First and Last Name)

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* 3. Point of Contact Email Address

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* 4. Point of Contact Phone Number

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* 5. Anticipated Number of Attendees

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* 6. Do you have a facility to host the training?

Yes

No

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* 7. If you answered yes to questions 6, what is the name and address of facility?

Facility Name

Facility Address

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* 8. Does the facility have the following amenities? Check all the apply.

Computer

Projector