Fields markes with (*) are required.
First Name *
Last Name *
your Email *
Street Address *
City *
State *
Zip *
Daytime Phone *
Cell
County *
Agency Affiliation *
Session times:
Webcasts are from 1:00 - 2:30 pm on January 18, February 15, April 18, and March 14, 2012.
Participants who come to Jefferson City will have a choice between a 1-day or 2-day training with the 1-day training always being the first date, e.g. January 31, February 14, and so on.
For one day : 10:30 AM -5:00 PM For two day training :10:30 AM- 5:00 PM ( First day ) 10:30 AM -4:30 PM ( Second day )
Please indicate the LEP Webcast Attended * Please Select Basic Level, April 18, 2012 Basic Level,January 18, 2012 Basic Level,February 15, 2012 Advanced Level,March 14, 2012 To Attend LEP Training
Please choose the Training Session you want to attend in Jefferson City * Please Select January 31-February 1, 2012 February 14-15, 2012 February 28-29, 2012 March 6-7, 2012 March 20-21, 2012 April 24-25, 2012 February 28, 2012 March 6, 2012 March 20, 2012 April 24, 2012 Attended Webcast
Please Indicate your LEP handout format * Please Select LEP handout format Paper format Electronic format Other format
If Other format, please indicate necessary accommodations
Please specify your First Legislative Priority *
Please specify your Second Legislative Priority *
Please specify your Third Legislative Priority *
Please specify your State Representative *
State Senator *
Does the Govenor's Council On Disability have your permission to take photos at the training?* Yes, I give permission to have my photos taken No, I do not give permission to have my photos taken
