Name

Email Address

Street Address

Address Line 2

City

Province

Postal Code

Phone

Message

Do you have a location that we can use to put on a live course? Do you have a location that we can use to put on a live course? Yes No

Do you financial capable to invest in and provide all requirements? Do you financial capable to invest in and provide all requirements? Yes No

Describe your knowledge about your local and state health department requirements: Describe your knowledge about your local and state health department requirements: Very knowledgeable Somewhat knowledgeable Not knowledgeable at all at this moment

Describe your experience with events: Describe your experience with events: Very experienced Somewhat experienced Minimal to no experience delivering live events

Describe your availability and desire to be involved with delivering courses: Describe your availability and desire to be involved with delivering courses: Totally available and very willing, flexible and motivated to organize live courses Somewhat available and interested in organizing live courses Available and interested to organize, with certain limitations (must discuss)