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2. 2 Day CPI (Crisis Prevention Intervention) Training for Providers

   Please complete the following information for each staff member attending.

4. Contact Information
6. First Name:*
7. Last Name:*
9. Organization / Agency Name:*
10. Job Title / Position:*
12. Address:*
14. City:*
15. State:*
16. Zip Code:*
18. Phone Number:*
19. Email Address:*
21. Dates *

    Class size is limited. A minimum of 12 participants is required per session, if minimum is not met then registrants will be scheduled for a different date. Please choose one of the scheduled sessions below. Participants much attend both days to receive certification.  

    1. Wednesday, January 4 & Thursday, January 5
    2. Wednesday, February 1 & Thursday, February 2
    3. Wednesday, March 1 & Thursday, March 2
    4. Wednesday, April 5 & Thursday, April 6

23. All trainings will be held at MCBDDS's Northview Center, 8114 N. Main St., Dayton, 45415 from 8:30 a.m. to 4 p.m. There will be a one hour lunch break. We encourage participants to bring their lunch or make use of nearby restaurants. 

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