Training or Events for the VIP Network Calendar
The purpose of this form is to make request that details of an upcoming event or training are included in the Violence and Injury Prevention (VIP) Network online calendar. We want to do the best job possible to promote your message, event, or training.
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Name *
Organization *
Email *
Injury Topic Area *
Examples include Child Maltreatment, Suicide, Motor Vehicle Safety, Sexual Violence Prevention, Child Fatality, Unintentional Injury, Older Adult Falls, Prescription Drug Overdose, and more
Event Name *
Event Host Organization(s) *
Date and Time of the event *
Location of the Event *
If it is web-based, feel free to add that below
Link for More Information or Registration *
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