Emergency Management Program Request Form

Please Enter Your Contact Information

Name:
Phone Number (xxx-xxx-xxxx):
E-mail:
Verify E-mail:
Please Indicate:
Student Faculty Staff Other
Requested Program:
Requested Date and Time (Please give at least two weeks' notice):
Proposed Location:
Comment:

Class Registration Requirements and Expectations

In requesting this course I acknowlege I will need to:
  • Have a group of at least 15 participants.
  • Provide a multi-media projector.
  • Have access to a room large enough in which to conduct practical exercises.

Please type "Yes" if you want to send this email.