B: Application for Facilitator (NAMI Family Support Group) July, 2019

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NAMI Wisconsin

Family Support Group Teacher Training
Date: July 12 - 13, 2019
Location: UW Eau Claire W.R. Davies Center (room 301)

This form must be completed by June 12, 2019.

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* 1. Which NAMI Wisconsin Affiliate is sending you to this training?

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* 2. Your Contact Information

First and Last Name *

Address *

Address 2

City *

State *

ZIP/Postal Code *

Email Address

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* 3. Phone number (you may be contacted by our trainer)

Please sign your initials in agreement next to each of the following statements:

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* 4. I make a commitment to attend the 2 day training program July 12 - 13, 2019.

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* 5. I understand that NAMI Wisconsin will pay for the initial training, training materials and meals during training. Costs for travel to and from this training, all lodging and the meals on Thursday and Saturday evening are the responsibility of myself or my sponsoring affiliate.

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* 6. I will honor the NAMI Family Support Group Implementation Requirements.

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* 7. I understand that I will have to read aloud share my experience and speak in front of a group at this training and while facilitating a support group.

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* 8. In addition, I acknowledge that all facilitator materials and handouts are protected by copyright and will not be copied without written permission of the copyright holder.

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* 9. Do you have any dietary allergies or restrictions or physical accommodations we should know about? Please describe.