Savage Sisters Substance Use Education and Overdose Reversal Training Request

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please email liddy@savagesisters.org upon completion of this form, thank you!

Please provide your Name, Email, and Phone Number *

Please provide the date and time for training requested : *

Please provide the location of the training: *

Will there be a tv we can plug a laptop into, or a projector we can use to share our slides? *

Please provide the name of the entity the training is being presented to : *

What type of entity is requesting the training? *

Highschool

Business

Harm Reduction Organization

Place of Worship

Recovery Home

University / College

Other

What type of training would those viewing be most likely to benefit from? *

Overdose Prevention and Reversal Training

Student Overdose Prevention and Reversal Training

Harm Reduction Training

Wound Care Training

Street-based Outreach Training

Xylazine Education Session

Fentanyl Test Strip Training

Other Speaking Commitment

Required

How many people will be in attendance approximately? *

Would you like us to bring naloxone (Narcan) to distribute to those in attendance? If yes, how many? *

The fee for our trainings is $500, via Zoom or in person, with additional fees applicable if significant travel time for in-person trainings is required. If you would like us to send you a W9, please type in "Yes," and provide the email we can send it to. *

The fee can be waived if you or the entity you represent is unable to afford it.

Send fee waiver request form

Do not send fee waiver request form

Clear selection

Additional questions/ details:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms