Bring CRT to Your City!

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    Date:                                                

    Your name:                                   

    Your organization/agency:  

    Your occupation:                        

    Email Address:                          

    City and State requested:          

    Classes interested in:           

    Preferred dates of training:  

    Potential venue*:                 

    *Venue must fit within CRC criteria – questionnaire

    Do you have a contact at the potential venue site: Y/N 

     

    Are you able to personally help with on the ground promotion? (i.e. contacting/providing contact to local first responder groups, etc)  Y/N 

    Other agencies interested in this training: 

    Contacts to those agencies:    

     

     

    Additional information that would be helpful in determining training potential: