Group Crisis Intervention (CISM)
September 30 - October 1, 2024
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These fields are required
1
Your Contact Info
The person named in this section is considered an attendee.
First Name
*
Last Name
*
Email
*
Confirm Email Address
*
Cell Phone
*
REQUIRED FORMAT: 000-000-0000
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2
Additional Registrants
Additional personnel you list below will receive an email to complete their
Registration Details
.
Guest
1
First Name
*
Last Name
*
Email
*
Guest
1
First Name
*
Last Name
*
Email
*
After completing this form, emails will be sent to everyone in your group to complete their information.
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3
Your Registration Details
Agency Name
*
Please do not abbreviate.
Your Position
*
(e.g.) Deputy, Police Officer, Detective, Social Worker, Sergeant, Dispatcher, etc...
Address 1
Example: 405 Main Street (Avenue, Lane, Circle, Trail, etc...)
Address 2
Example: Apt 8, Suite 405, Unit 10, etc...
City/Town
State/US Territory
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Deleware
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Texas
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Washington
Washington D.C.
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Zip Code
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