EmailMe Form - The 84 Training Request Form

Chapter name

Adult advisor

First Last

(the adult attending the training)

Adult email

Adult Cellphone (we will only use this to contact you on the day of the training if necessary) *

### - ### - ####

How many youth will attend?

(Max 20)

Training *

Are you willing to host the training in your space?

Yes

No

Please list possible dates and times that would work for your Chapter.

Please provide three dates with AT LEAST THREE WEEKS' NOTICE so we can follow up with you about a potential time. *

A member of the 84 staff will be driving to your training. Where is the best place for us to park? *

Please provide the address and contact person information for pizza delivery.

Note: The 84 will cover the cost of the pizza.

Please explain any dietary needs of attendees, if applicable.