Request a Workshop or Training on Domestic Violence

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* Your Name:
  Your agency/organization:
* Your daytime phone number (including area code): 
* Your e-mail address:
* Address:
* Town/City and State:
  Please describe what topics you are interested in, and any other special requests for this training or workshop:
  Proposed beginning date:
  Proposed end date:
  Expected number of participants:
  To whom will this training or workshop be presented?
  I am requesting: One-time session with one group.
One-time sessions with multiple groups.
Series of sessions with one group.
Series of sessions with multiple groups.
  What prompted your request:
  Additional information:

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