Name (Executive Director or Administrator)
(Required)
First
Last
Name of contact person
(Required)
Agency
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone number
(Required)
Date of desired training session
This field is optional
MM slash DD slash YYYY
Time of desired training session
This field is optional
Hours
:
Minutes
AM
PM
AM/PM
Select the training session you would like to host
(Required)
Passenger Assistance Training (PAT) - Full Day
Defensive Driving
Accessible Lift & Securement (Half Day)
CPR
Disability Awareness
How many attendees from your agency will be in attendance
(Required)
Up to 8 attendees from host agency allowed
Please enter a number less than or equal to
8
.
Do you have an accessible vehicle available for the training session?
(Required)
Accessible vehicles are only required for hands-on training sessions. Please state whether you have more than one vehicle available.