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CEI HIV Training Intake Form
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* Indicates required question
First and Last Name
*
Your answer
Email Address
*
Your answer
Phone number
*
Your answer
Organization Name
*
Your answer
Organization's Address (city, state, zip)
*
Your answer
Organization County
*
Your answer
What type of training program would you like to schedule?
*
Single training
Training series - 2-6 trainings (multiple trainings spread across different days/weeks)
What training format are you interested in?
*
Virtual (Zoom webinar) training
In-person training (on a case-by-case basis)
Either virtual or in-person training
Required
How many people do you anticipate attending this training? (Minimum of 10 participants)
*
1
2-9
10-19
20+
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