Living Well Workshop Interest Form

 
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1. Please provide the name of your organization or company.
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2. Organization, Company or Facility Address
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3. Please provide the name of the primary contact for your organization.
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4. Please provide the primary contact person e-mail address.
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5. Please provide the primary contact person's telephone number.
6. Please provide the primary contact person's fax number.
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7. Which option best describes your organization or company type?
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8. Please provide your "Living Well" workshop interest(s):
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9. Please provide your Organization’s preferred method for follow-Up
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10. To meet the needs of each organization, Living Well in Georgia workshops schedules (including start dates and times) and locations are coordinated with each interested organization. Please provide a preferred "Living Well" workshop start period (by month).
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11. Please provide a preferred day of the week for a "Living Well" workshop to be conducted on-site.

Friendly Reminder: Workshops would be conducted only one day each week for a period of 6 consecutive weeks.
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12. Please provide a preferred time frame for a "Living Well" workshop to be conducted on-site.
13. Members of your organization or company are also welcome to receive free trainings to become "Living Well" program lay leaders. Please share if your organization's staff or volunteers are interested in participating in future Lay Leader trainings.
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