Returning TBI Member Form 2016-2017
Name
Your answer
Job Title
Your answer
What region are you in?
District/Organization
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Email Address
Your answer
Mailing Address (street, city, zip code)
Your answer
Would you be willing to be contacted by other members of the TBI Team to share specialized knowledge pertaining to a case?
Supervisor's Name
Your answer
Supervisor's Email Address
Your answer
Supervisor's District/Organization
Your answer
Do you have your supervisor's approval to participate on the TBI Team?
Have you spoken to your regional liaison?
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