Remembering When

Submitted by dclewis1 on Tue, 08/11/2020 - 14:06

Please do not proceed with this form unless you have completed a Train the Trainer course with NC DOI-OSFM and can provide the training date below.

A maximum of 50 incentive items can be sent for your presentation. Incentives are intended for small group presentations and not large safety fairs or events.

Indicates required field

Contact Information

First

Last

Agency

Address

City/Town

State

ZIP/Postal Code

Event Information

Event Date and Time

Address

City/Town

State/Province

ZIP/Postal Code

Type of Facility

County

Approximate Number of Attendees

Presentation Type

Group

Home Visit

Smoke Alarm Installation

Materials Covered

Fall Prevention

Fire Prevention

Both

Remembering When Train the Trainer Attended

Date of Training Attended

Location of Training

PLEASE NOTE: Requests should be submitted three weeks in advance to ensure receipt of incentives. Our office will arrange delivery or mailing of your incentives. Incentives will be determined based on availability and number of attendees.

This question is for testing whether or not you are a human