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Training Request Form
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Your name
Email Address
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Name of Training
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Speaking Activity Requested
Speaking Activity Requested
In-person presentation
Keynote
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Opening or closing remarks
Webinar or other presentation conducted virtually
Other
Other
What topics are you interested in?
What Topics are you Interested In
Benzodiazepine deprescribing and post-acute withdrawal
Local government policies and programs in response to the opioid crisis
Medical Provider/Patient communication
Medication-Assisted Treatment
Non-opioid pain management
Opioid naïve patient and how to treat
Opioid prescribing and tapering
Substance Use Disorder (SUD)
Other
Other
When is your event? (Date and time of day)
Date and time of day)
Please tell us about your event
Please tell us about your event
What is the size of the expected audience?
size of the expected audience
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Event Address
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State
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Zipcode
County or counties serving
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Message
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